Florence Nightingale: The Crimean War: Collected Works of Florence Nightingale, Volume 14

By Wilfrid Laurier University Press

Florence Nightingale is famous as the “lady with the lamp” in the Crimean War, 1854—56. There is a massive amount of literature on this work, but, as editor Lynn McDonald shows, it is often erroneous, and films and press reporting on it have been even less accurate. The Crimean War reports on Nightingale’s correspondence from the war hospitals and on the staggering amount of work she did post-war to ensure that the appalling death rate from disease (higher than that from bullets) did not recur.

This volume contains much on Nightingale’s efforts to achieve real reforms. Her well-known, and relatively “sanitized”, evidence to the royal commission on the war is compared with her confidential, much franker, and very thorough Notes on the Health of the British Army, where the full horrors of disease and neglect are laid out, with the names of those responsible.

• Language: English
• Publisher: Wilfrid Laurier University Press
• Release date: Feb 1, 2011
• ISBN: 9781554587476

Book preview

FLORENCE NIGHTINGALE:

THE CRIMEAN WAR

VOLUME 14

OF THE COLLECTED WORKS OF

FLORENCE NIGHTINGALE

THE COLLECTED WORKS OF

FLORENCE NIGHTINGALE

LIST OF VOLUMES

Note: Short title denoted by bold.

Edited by Lynn McDonald, except as indicated.

FLORENCE NIGHTINGALE:

THE CRIMEAN WAR

LYNN MCDONALD, EDITOR

VOLUME 14

OF THE COLLECTED WORKS OF

FLORENCE NIGHTINGALE

We acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program for our publishing activities.

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Library and Archives Canada Cataloguing in Publication

Nightingale, Florence, 1820–1910

Florence Nightingale: the Crimean War / Lynn McDonald, editor.

(Collected works of Florence Nightingale; v. 14)

Includes bibliographical references and index.

Issued also in electronic format.

ISBN 978-0-88920-469-0 (bound)

1. Crimean War, 1853–1856 — Medical care. 2. Crimean War, 1853–1856 — Health aspects. 3. Great Britain. Army — Medical care — History —19th century. 4. Soldiers — Health and hygiene — Great Britain — History—19th century. 5. Nightingale, Florence, 1820–1910. 6. Crimean War, 1853–1856 — Personal narratives, British. I. McDonald, Lynn, 1940–   II. Title. III. Title: Crimean War. IV. Series: Nightingale, Florence, 1820–1910. Collected works of Florence Nightingale; v. 14.

DK215.N54 2010     947′.07387     C2010-905173-4

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Library and Archives Canada Cataloguing in Publication

Nightingale, Florence, 1820–1910

Florence Nightingale [electronic resource]: the Crimean War / Lynn McDonald, editor.

(Collected works of Florence Nightingale; v. 14)

Includes bibliographical references and index.

Issued also in print format.

ISBN 978-1-55458-245-7

1. Crimean War, 1853–1856 — Medical care. 2. Crimean War, 1853–1856 — Health aspects. 3. Great Britain. Army — Medical care — History —19th century. 4. Soldiers — Health and hygiene — Great Britain — History—19th century. 5. Nightingale, Florence, 1820–1910. 6. Crimean War, 1853–1856 — Personal narratives, British. I. McDonald, Lynn, 1940–   II. Title. III. Title: Crimean War. IV. Series: Nightingale, Florence, 1820–1910. Collected works of Florence Nightingale; v. 14.

DK215.N54 2010a     947′.07387     C2010-905174-2

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© 2010 Wilfrid Laurier University Press

Cover design by Leslie Macredie. On the front cover is the iconic painting Mission of Mercy: Florence Nightingale Receiving the Wounded at Scutari (1858), a composite scene by Jerry Barrett. Reproduced courtesy of the National Portrait Gallery. The front flap shows one of Nightingale’s pioneering area charts adapted to a new issue—climate change. Emissions data of 2006 from the Energy Information Administration, population data of 2007 from the Population Reference Bureau. Chart prepared by Lynn McDonald and Patricia Warwick. On the back cover is one of Nightingale’s classic rose or area charts, Diagram of the Causes of Mortality. The image on the back flap—a modified clock chart that uses the same data as the area charts on the back cover—was prepared by Lynn McDonald and Patricia Warwick.

   Printed in Canada

Every reasonable effort has been made to acquire permission for copyright material used in this text, and to acknowledge all such indebtedness accurately. Any errors and omissions called to the publisher’s attention will be corrected in future printings.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without the prior consent of the publisher or a licence from The Canadian Copyright Licensing Agency (Access Copyright). For an Access Copyright licence, visit www.accesscopyright.ca or call toll free to 1-800-893-5777.

Wilfrid Laurier University Press

Waterloo, Ontario, Canada N2L 3C5

E-mail: [e-mail]

Web: www.wlupress.wlu.ca

Collected Works of Florence Nightingale website:

www.sociology.uoguelph.ca/fnightingale

CONTENTS

Acknowledgments

Dramatis Personae

List of Illustrations

Florence Nightingale: A Précis of Her Life

An Introduction to Volume 14

A Chronology of the Crimean War and Nightingale’s Work

Background on the Crimean War

Medical Science at the Time of the Crimean War

Investigations of the Crimean War

Secondary Sources on Nightingale and the Crimean War

Key to Editing

Letters from the Crimean War

Preparations, Departure and Travel

1855

1856

On Return from the Crimean War

1857-58

Nightingale’s Reports on the Crimean War

Notes on the Health of the British Army

Answers to Written Questions

Promotion and Distribution of the Reports

Epilogue: The Formative Influence of the Crimean War

Bibliography

Index

ACKNOWLEDGMENTS

Acknowledgments are due to a large number of individuals and organizations for assistance on this volume, and for assistance at all stages in the Collected Works project. First of all acknowledgments are due to the Henry Bonham Carter Will Trust for permission to publish Nightingale original manuscripts, and indeed for treating Nightingale material generally as being in the public domain. To the owners of Nightingale manuscripts thanks are due for their important role in conservation, for permitting scholarly access and for permitting copies to be made for this Collected Works.

Many people worked on the preparation of the texts, many as volunteers. Thanks are due to transcribers Gwyneth Watkins and Victoria Rea; verifiers of texts and assistance with proofreading, Patricia Warwick, Antonia Butler, Mary Boyce and Arun Dhanota. Thanks to Patricia Warwick for assistance with visuals and technical support. Thanks to biographer Mark Bostridge for sharing his archival research notes and to Dr Maria Luddy for Convent of Mercy materials.

Archivists and librarians around the world provided skilled assistance, often beyond the call of duty. New material appeared by e-mail thanks to alert archivists and researchers in several countries. Author Hugh Small kindly supplied scans from his private collection of Nightingale material.

At Wilfrid Laurier University Press thanks are due to Dr Brian Henderson, director; Rob Kohlmeier, managing editor; Heather Blain-Yanke, production manager; Doreen Armbruster, typesetter; Leslie Macreadie and Penelope Grows, marketing; Lisa Quinn, peer review; and Catharine Bonas-Taylor and Steve Izma, technical support. Thanks are due to the anonymous peer reviewers for helpful comments. The copy editing was done by Kristen Peterson Chew. Acknowledgments for photographs and other illustrations are given where they appear.

In spite of the assistance of so many people errors undoubtedly remain, which are the responsibility of the editor. We would be grateful for notification of any errors, and for information on missing identifications. Corrections will be made in the electronic text and any later print publications.

Collage of stamps commemorating Nightingale’s Crimean War work. Reproductions courtesy of Dr Gwen Prout.

DRAMATIS PERSONAE

Frances Nightingale (1788-1880), mother

William Edward Nightingale (1794-1874), father

Parthenope Nightingale (1819-90), later Lady Verney, sister

Mary Shore Smith (1798-1889), Aunt Mai, accompanied to Scutari

Samuel Smith (1794-1880), Uncle Sam, accompanied to Scutari

C.H. Bracebridge (1799-1872), family friend, accompanied to Scutari

Selina Bracebridge (1800-74), Σ, family friend, accompanied to Scutari

(Lady) Charlotte Canning (1817-61), ladies’ committee

(Lady) Cranworth (1807-68), ladies’ committee

Elizabeth Herbert (1822-1911), ladies’ committee, friend

Sidney Herbert (1810-61), secretary at war

(Dr) William Farr (1807-83), medical statistician

Dr (Sir) John Hall (1815-1866), inspector general of hospitals

(Sir) Benjamin Hawes (1797-1862), under secretary for war

Harriet Martineau (1802-76), journalist, friend

(Sir) John McNeill (1795-1883), supply commission

(Rev Mother) Mary Clare Moore, Sisters of Mercy, Bermondsey

Lord Panmure (1801-74), secretary for war

Lord Raglan (1788-1855), commander of the forces

(Lt Col) John Henry Lefroy, confidential agent of Lord Panmure

(Sir) Andrew Smith (1797-1872), director, Army Medical Department

Jane Elizabeth Shaw Stewart (c1821-1905), superintendent

(General Sir) Henry K. Storks (1811-74), commander in Turkey

(Dr) John Sutherland (1808-91), sanitary expert, collaborator

(Sir) Alexander M. Tulloch (1803-64), supply commission

Queen Victoria (1819-1901), monarch

LIST OF ILLUSTRATIONS

Postage stamps commemorating Nightingale’s Crimean War work,

Key sites of the Crimean War,

Drying closet used by the hospital at Scutari,

Nightingale letter to the family of a dead soldier from the Derby Mercury,

Inscription on a Bible sent to Nightingale by an admirer,

Original title page of Nightingale’s confidential report,.

Covering letter Nightingale sent with the confidential report,

Illustrations facing page 530

1. The council of war (June 1855) of the three army commanders.

2. Lady Canning and Dr (Sir) John Hall.

3. Lord Panmure and Sidney Herbert, secretaries for war.

4. Diagram of the mortality in the hospitals of Scutari and Koulali.

5. Nightingale’s classic charts, Diagram of the causes of mortality.

6. The sanitary commissioners, Dr Sutherland and Rawlinson.

7. Modified clock chart, from Nightingale’s classic rose charts.

8. Photographs of the Barrack Hospital, Scutari.

FLORENCE NIGHTINGALE: A PRÉCIS OF HER LIFE

Florence Nightingale was born in Florence, Italy, 1820, the second daughter of wealthy English parents taking an extended European wedding trip. She was raised in England at country homes, Lea Hurst, in Derbyshire, and Embley, in Hampshire. She was educated largely by her father, who had studied classics at Trinity College, Cambridge. At age sixteen Nightingale experienced a call to service, but her family would not permit her to act on it by becoming a nurse, then a lower-class occupation and thoroughly unthinkable for a lady. Lengthy trips were allowed, to Rome (1847-48) and Egypt and Europe (1849-50). She had earlier (1837-39) been taken on a long trip with her family, mainly to Italy and France. These European trips not only improved her language skills (she was fluent in modern French, German and Italian as well as competent in ancient Latin and Greek), but exposed her to republican politics and Italian independence (she was in Rome and France during the revolts of 1848).

Nightingale was finally permitted to spend three months at the (Protestant) Deaconess Institution in Kaiserswerth, near Düsseldorf, Germany, in 1851 and several weeks with Roman Catholic nursing orders in Paris in 1853. Her father gave her an annuity in 1853 to permit her to become the superintendent of the Establishment for Gentlewomen during Illness, Upper Harley Street, London. She left there in 1854 to lead the first team of British women nurses sent to war. The British Army was poorly prepared for that war and the death rate from preventible disease was seven times that from wounds. The Barrack Hospital at Scutari, where she was stationed, was structurally unfit to be a hospital, had defective drains and had to be re-engineered by a team of visiting experts before the death rate could be brought down.

Nightingale’s work as a public health and social reformer effectively began on her return from the Crimean War in 1856. Recognized as a national heroine, she chose to work behind the scenes for structural changes to prevent that war’s high death rates from ever recurring. She lobbied to get a royal commission established to investigate the causes of the medical disaster and recommend changes. She herself briefed witnesses, analyzed data and strongly influenced the thrust of the report. At the same time she worked on a confidential report, which was to be a précis and take six months, but which turned out two years later to be an 853-page treatise. Both this comprehensive report, here abbreviated as Notes on the Health of the British Army, and the official royal commission report were finished in 1858.

Nightingale fell ill while doing this work, it is thought from the chronic form of brucellosis, the disease from which (again this is conjecture) she nearly died in the war. She spent most of the rest of her life as an invalid, seeing people on a one-to-one basis and making her influence by research and writing. The illness was certainly painful and incapacitating, but Nightingale learned how to work around it, to focus her hours of working time on the most important projects, that is, those with the best prospect of saving lives.

Nightingale was baptized in the Church of England and remained in it for the rest of her life, although often despairing of its paltry role for women, the minimal demands it made of its adherents generally and its social conservatism. Her experience of religious conversion in 1836 and call to service in 1837 (the latter specifically dated 7 February and frequently referred to) were both shaped by reading the work of an American Congregational minister, Jacob Abbott, notably The Corner-stone. Her faith was nourished by broad reading, from the medieval mystics, liberal theologians and the German historical school to contemporary sermons, popular devotional books, tracts and religious novels. The family had been largely Unitarian in earlier generations, but her paternal grandmother was evangelical Church of England. Her parents took the family to the Church of England while at Embley, Wesleyan chapels while at Lea Hurst. There are Lutheran influences also on Nightingale from her Kaiserswerth time.

God for Nightingale was a perfect Creator who made and runs the world by laws, which human beings can ascertain by rigorous, preferably statistical, study. With the knowledge thus gained we can then intervene for good, thus becoming God’s co-workers. Ongoing research is required, for human interventions, however well intentioned, may have negative, unintended consequences. This approach appears in all the work Nightingale did, whether on health care, the army or social reform more broadly.

To guide her in doing the research necessary to discover God’s laws Nightingale developed an effective methodological approach. Her sources were L.A.J. Quetelet, a Belgian statistics expert, on the conduct of research, and J.S. Mill on the philosophical grounding. The successful use of this methodology is evident in Public Health Care, and on maternal mortality in Women.

Nightingale’s ardent and consistent liberal politics are another theme informing her social reform work. Her family (and the Verney family, into which her sister married) were strong Liberal supporters. Her brother-in-law was a Liberal MP, as were cousins and family friends. She herself gave money to the Liberal Party and even wrote campaign letters for (a small number) of (suitably progressive) Liberal candidates. At a time of considerable political flux Nightingale’s politics were consistent: she was a thorough small l liberal in her ideas, a supporter of freedom of inquiry and expression and an advocate of religious toleration. The Liberal Party seemed to be the best political manifestation of these goals. Again, as with the Church of England, the Liberal Party often failed to live up to its principles—she desperately wanted Liberal governments to be liberal on India as it was on Ireland.

For most of her long working life Nightingale was confined to her room, describing herself variously as a prisoner to my room or even a prisoner to my bed. Some days she could not see anybody, but usually she had interviews, sometimes several and sometimes lengthy ones, with nursing leaders, probationers, medical experts, politicians and Indian officials. Many people who requested interviews with her were turned down. Time with family and friends was fitted in around this business, God’s business in her understanding, saving lives. People who did not get interviews, however, normally got letters in reply, often long and careful explanations, and offers of assistance.

Nightingale added to her network as newer, younger experts, MPS and officials came into office. She always worked collectively, seeking advice from experts variously military, statistical, medical and nursing. She had her own articles and reports vetted by appropriate experts. When she could not aid the cause for someone, she suggested someone who could.

Nightingale continued to produce papers and reports of various kinds well into her seventies. She did not do any serious writing in her eighties, when blindness and failing mental faculties gradually stopped her. There are brief messages only from 1902 on. She was given honours in her last years (the Order of Merit in 1907) and enjoyed the company of younger relatives and several close nursing friends. She died at ninety and was buried in the churchyard of St Margaret’s, Wellow, the family’s parish church. Consistent with her wishes, the family declined an offer of burial at Westminster Abbey.

Key Sites in the Crimean War.

1. At Varna, troops were stationed July-August 1854.

2. At Kalamita Bay, troops landed in September 1854.

3. The Battle of Inkermann took place 5 November 1854.

4. At Scutari was the Barrack Hospital, Nightingale’s main hospital. Sick and wounded soldiers had to be transported 300 miles from Balaclava to Scutari.

AN INTRODUCTION TO VOLUME 14

Florence Nightingale is still, for many people around the world, the heroine of the Crimean War (1854-56), the lady with the lamp whose presence on her late-night walks through the Barrack Hospital, Scutari, comforted sick and wounded soldiers. That status as a legend in her time, however, has been challenged in recent years. A whole new so-called critical literature has developed, with books, articles and television films based on them, contending that she was no less than a villain: the very person responsible for the high rates of death in the war hospitals. The scene of her worst alleged crimes was that Barrack Hospital, the one where the War Office sent her.

Two BBC films, in 2001 and 2008,¹ brought this far-fetched message, for which primary sources are entirely lacking, to millions. Coverage of the films in such respectable newspapers as The Guardian and the Sunday Times embellished the charges, while ignoring the unsensational, but more accurate, material included in the quasi-documentaries.

The accusations vary in scope and motive, but all are bad enough. According to the Sunday Times coverage of the 2001 BBC film, hundreds of wounded soldiers died unnecessarily, thanks to Nightingale, a manipulative, neurotic and sexually repressed woman. This accusation was ramped up in the 2008 BBC film to the saintly nurse being the kiss of death to thousands of men in her care.² The source of the accusations picked up by the BBC filmmakers is a 1998 book by Hugh Small, Florence Nightingale: Avenging Angel. For the most part, Small gives a favourable report of Nightingale’s work, although these points were ignored by later authors and other media. Small in fact did a considerable amount of research into the primary sources, but he paid almost no attention to the most comprehensive primary source, her massive report on the war, and ignored key correspondence.

The factual errors conveyed in these books, films, etc., are discussed briefly near the end of this introduction in Secondary Sources on Nightingale and the Crimean War. For the moment, suffice it to say that it is high time that what Nightingale actually did at her hospital, and at others for which she had responsibility, be made known.

Preceding this volume in the Collected Works are two volumes of introductory, family-related material (volumes 1 and 7, Life and Family and European Travels), four volumes on her faith and religious views (volumes 2 to 4, Spiritual Journey, Theology, Mysticism and Eastern Religions, and volume 11, Suggestions for Thought), a volume on her methodological and political foundations (volume 5, Society and Politics), one on health care (volume 6, Public Health Care), two volumes on India (volume 9, Health in India, and volume 10, Social Change in India), two on nursing (volume 12, The Nightingale School, and volume 13, Extending Nursing). To follow are volume 15, Wars and the War Office, and the final volume 16, Hospital Reform.

While Nightingale’s evidence given to the royal commission, Answers to Written Questions, was published and is relatively available, her far more substantial confidential report, Notes on the Health of the British Army, was printed for private circulation, but not published. It seems hardly ever to have been read, let alone seriously discussed, by scholars. That there is only a hard-to-read microfilm of this report, but not a print copy, in the interlibrary loan system of the United States and Canada, suggests some of the difficulty. Copies are available in (mainly British) libraries.

Authors have blithely ignored it, making their (often preposterous) assessments of her Crimean War work on the basis of secondary sources, which likewise have ignored this essential 853-page document. Her correspondence is better known, thanks to the publication of 100 selected letters, along with superb introductions.³ Yet other pertinent letters and many notes and drafts have been missed, and these appear here in print for the first time.

To give some context to the available material, Nightingale spent only eighteen months doing actual nursing and administration during the war. She spent at least the same length of time postwar analyzing what went wrong and devising a better system to prevent similar disasters. Her great work, Notes on the Health of the British Army, was commissioned by Lord Panmure in his capacity as war secretary, and was to be a précis that would take six months to complete. Nightingale originally referred to it as a précis as well, but it would take much longer, and two sets of printing (at her own expense), before she was satisfied with it. The eventual 853-page treatise is described on the title page as Presented by Request by the Secretary of State for War, but significantly it was not presented to Parliament. Notes on the Health of the British Army is treated here as a central document, as it was for Nightingale, the one that grounded so much of her work not only in the immediate postwar period but for the rest of her whole long life.

Volume 14 unfolds largely in chronological order. After the introductory material comes the great bulk of correspondence from the war. The letters are almost all on the business at hand, with little reflection. On Nightingale’s return to England in August 1856, the subject matter largely shifts to what went wrong and what changes should be effected. Major sections (but not all) of Notes on the Health of the British Army are included here. This is followed by her shorter Answers to Written Questions, in full, then correspondence on the promotion of action on the recommendations.

The last instalment of correspondence runs from the late 1870s to the end of Nightingale’s life. It covers celebrations of Balaclava survivors and other commemorations of the war and more personal recollections from late in her life, along with comments (often negative) on books about the war. After Nightingale’s last reflections, an epilogue assesses the formative influence of the war on her life and work, in terms of her views, working practices and ongoing relationships grounded on the Crimean War work.

There are differences in tone and focus of concern between correspondence written during the war and that written after it, when Nightingale was researching what went wrong. Her post-Crimea War reports are devoted nearly entirely to the analysis of mistakes and prescription of better alternatives. While actually on the job during the war, Nightingale was overwhelmingly concerned with immediate tasks and crises: the influx of sick and wounded soldiers, the lack of supplies, the occasional opposition of doctors, and more frequent opposition of other officials, difficulties presented by the nurses, along with their illnesses and some deaths, with related correspondence about funerals and the disposition of effects. There are letters to soldiers’ families about their loved ones’ last days and hours, and sometimes of their pay and effects. Faults in diet, cleanliness, laundry and medical comforts appear in tedious detail. There was no time to look for underlying causes, and any solutions proposed were of an immediate nature only.

Reflective remarks in her war letters are rare, and not very helpful. Nightingale mused, for example, on Iphigenia of Tauris (Tauris was the ancient Greek name for the Crimea), from Euripides’ tragedy (Iphighenia was sacrificed by her father Agamemnon). She cited Dante’s Inferno when describing the horrors of the trenches at Sebastopol: abandon hope all ye who enter here. She felt herself in a Greek tragedy, where all is "fated to ruin … like Prometheus bound to the rock (see p 204 below). She also used biblical imagery, musing that war makes Deborahs and Absaloms and Architophels" (see p 258 below).

The following chronology gives an overview of the whole period. Events are lined up on the left, Nightingale’s work on the right.

A Chronology of the Crimean War and Nightingale’s Work

29 March 1853 Turkey declares war on Russia

2 July 1853 Russia occupies Moldavia and Wallachia, south of the Danube

November 1853 Russian massacre of Sinope: sinking of Turkish fleet, death of 4000 men

6 March 1854 Income tax raised in Britain to pay for war

26 March 1854 France declares war on Russia

27 March 1854 Britain declares war on Russia

April-June Troops arrive in Varna, deaths from cholera and dysentery, malnutrition

21 June 1854 Sewer cleansing, etc., first ordered for General Hospital, Scutari

28 June 1854 British Cabinet decides on invasion of Russia in Crimea

4 August 1854 Sewer cleansing, etc., first ordered for Barrack Hospital, Scutari

end August 1854 Troops leave Varna camps, board ships for departure

7 September 1854 Troops leave for Crimea; large numbers die en route, arrive at Kalamita Bay, sick cannot carry packs, transport lacking, packs left behind

13-14 September 1854 Troops land unopposed at Eupatoria

20 September 1854 Battle of the Alma; British advance closer to Sebastopol

11 October 1854 Lady Maria Forester approaches FN about taking nurses to the war

15 October 1854 Sidney Herbert asks FN to lead a team of British nurses; FN writes Elizabeth Herbert about going

17 October 1854 FN meets with duke of Newcastle, calls on Dr Andrew Smith

19 October 1854 Sidney Herbert official letter of instructions to FN

20 October 1854 FN meets jointly with the duke of Newcastle, Sidney Herbert and Dr Andrew Smith

21 October 1854 FN and thirty-eight nurses depart from England

25 October 1854 Battle of Balaclava, Charge of the Light Brigade

4 November 1854 FN and nurses arrive at Constantinople

5 November 1854 Battle of Inkermann

FN and nurses arrive at Scutari Barrack Hospital

17 November 1854 Further request made for cleansing of toilets at Scutari

15 December 1854 Raglan censures Dr Hall in a general order

17 December 1854 Stanley group, with Irish Sisters of Mercy, arrive at Constantinople

29 January 1855 Roebuck resolution adopted for a select committee to investigate condition of the army; Aberdeen government resigns, replaced by Lord Palmerston, departure of Sidney Herbert as war secretary, replaced by Lord Panmure

February 1855 Sanitary commission appointed, with power to correct bad conditions; supplies commission appointed

5 March 1855 Sanitary commission arrives at Scutari

6 March 1855 Supplies commission arrives at Scutari

March 1855 Pathological commission appointed

1 April 1855 FN given responsibility of newly opened Castle Hospital, Balaclava

5-6 May 1855 FN begins first visit to Balaclava

7 May 1855 FN visits Crimean hospitals, trenches, meets with sanitary commission

13 May 1855 FN falls ill of Crimean fever at Balaclava

18 June 1855 Roebuck committee reports

24 June 1855 Raglan visits FN

4 June 1855 FN returns to Scutari for convalescence

28 June 1855 Lord Raglan dies

8 September 1855 French attack Malakoff, British the Redan

9 September 1855 Evacuation of Sebastopol by the Russians, entry by the allies the next day

Early October 1855 FN begins second visit to Balaclava

27 November 1855 Meeting at Willis’s Rooms, London, chaired by the duke of Cambridge, to establish the Nightingale Fund

28 January 1856 Victoria Cross established by the queen, For Valour

25 February 1856 Congress of Paris opens, works towards a peace treaty

ca. 22 March FN begins third visit to Balaclava, cleans up Balaclava hospitals and establishes nursing at Land Transport Corps hospitals

30 March 1856 Treaty of Paris signed, ending Crimean War

11 April 1856 General order confirms FN’s authority over all nurses ca. 15 May 1856 FN returns to Scutari from Balaclava

28 July 1856 After last soldier in hospital leaves, FN leaves for England with her aunt

6 August 1856 FN and aunt arrive in England

Late September-early October 1856 FN at Balmoral Castle, meets with Queen Victoria, Prince Albert, Lord Panmure

ca. October 1856 Lord Panmure informally commissions précis on Crimean War, FN begins work on it

18 February 1857 Panmure formally writes FN requesting her observations

end April 1857 Warrant for appointment of royal commission issued

May-September 1857 FN briefs witnesses for royal commission, does statistical work for both reports

February 1858 Royal commission report published

February 1858 FN works on reviews for royal commission report early October 1858 FN sends confidential report to queen, Panmure and trusted influential people

1858 FN publishes Mortality of the British Army at Home and Abroad

1859 FN publishes A Contribution to the Sanitary History of the British

Army, in reply to Andrew Smith’s Medical and Surgical History of the British Army

* * * * *

On 20 October 1854, the eve of her departure, Nightingale wrote in her copy of Thomas à Kempis, Imitation of Christ, a prayer of dedication, that nothing that happened to her would be but what God ordained, and that she joined her sacrifice to that Jesus Christ, the Saviour. In Mysticism and Eastern Religions (4:84).

Background on the Crimean War

What became commonly known as the Crimean War⁴ (the term used routinely here), was fought 1854-56 by an alliance of Britain and France in support of their traditional ally, Ottoman Turkey, against Russia, seen as the tyrannical enemy. The war was not called the Crimean at the time, for it was not known when the troops left that the Crimea would be the place of invasion. Since a major cause of the war was Russia’s expansion in the Balkans, south of the Danube, threatening Western countries, it was thought that battle would be engaged in what is now Bulgaria and Romania and alliance troops were sent there first. The Russians called it the Eastern War, and Nightingale often referred to the army in the East, which conveniently includes both Scutari, in Turkey, and the Crimea, in Russia. Neither the royal commission report nor her confidential report use the name Crimean War. The royal commission report specifies no war, while Nightingale’s refers only to the late war in its title. One reprinted document even calls it the Russian War, Mortality of the British Army, at Home, and Abroad, and During the Russian War, As Compared with the Mortality of the Civil Population in England.

Britain and France had, for some time, been supporting Turkey, the declining Ottoman Empire, as a buffer against the more threatening and expanding Russian empire. Turkey’s decline was considered an opportunity for Russia to move in, even possibly taking Constantinople and threatening British and French control of the Mediterranean. Britain wanted to keep its sea route to India unhindered. Russia was also a threat to India if it occupied Afghanistan (keeping troops in the Crimea made them unavailable there). That the tsar called Turkey the sick man of Europe gave pause for thought.

The superficial causes of the war—control over certain churches in the Holy Land and the status of Christians in Muslim Turkey and its territories—were not the real concerns. Moreover, the complicated intrigues over them between Roman Catholics and Orthodox Christians would take too much space to report to be worth the trouble. Threats and proposals went every which way. In 1850 Louis-Napoléon (soon to become Emperor Napoleon III) began to champion Roman Catholic joint control with the Orthodox Church over the great religious sites. This caused an uproar in Orthodox Russia. Monks were actually killed in a riot at the Church of the Nativity in Bethlehem.

Behind the scenes, the British sent out conflicting messages. Lord Palmerston, then home secretary, was a known Russophobe, as were W.E. Gladstone, then chancellor of the Exchequer, and the British ambassador to Turkey, Lord Stratford de Redcliffe. Lord Stratford had an additional grievance, having been turned down by Tsar Nicholas I when proposed by the British government as ambassador to Russia. The French were pressing for war even more than the British—the new emperor saw gains in his own prestige to be made—and in fact committed more troops (and better equipment) to it.

In July 1853 Russia invaded Turkish Moldavia and Wallachia (now Moldova and Romania), then autonomous regions of the Ottoman Empire. The Russians crossing the Danube frightened the Austrians, even though Russia had helped them put down the 1848 Hungarian revolt. For Western liberals, the Russia expansion recollected that brutal suppression of Hungary. Nightingale told Margaret Verney late in life that the real cause of the Crimean War was not the holy places, but Russia marching into Hungary in 1848: The people of England were so furious with Russia for that scandalous act that, in 1854, nothing would satisfy them but war with Russia.⁵ Nightingale’s dislike and fear of Russia was reinforced by its oppression of Roman Catholics in what is now Belarus. While in Rome in 1848, she had met the Roman Catholic abbess of Minsk, a refugee when her convent was taken over by the Orthodox and many of her nuns slaughtered when they refused to convert.

After the end of the Crimean War, but while she was still in the East, Nightingale made some frank comments about Russian aggression, apparently in defence of the British-French invasion. The purpose of Sebastopol was aggressive fanaticism, she said, not defence. She could feel for the poor wretches who suffered and died defending it, but they did so to make Russia the tyrant of the world. She would like to have seen the Crimea held by us as the outpost of civilization— the Russians driven beyond the Caucasus, and the Caspian a sea of British trade (see p 411 below).

In November 1853 the Russian Black Sea fleet surprised the Turkish navy at the Turkish port of Sinope and sank the entire fleet. Some 4000 men died, including sailors who survived the sinkings only to be shot in the water. The massacre at Sinope aroused British public opinion against Russia so much that, when the Russian Army retreated from Moldavia and Wallachia in the spring of 1854, the invasion went ahead.

That the British Army was ill-prepared for the war is a gross under-statement. The army had not faced a strong, well-equipped army since the Napoleonic wars. It could easily defeat technologically weaker armies in Africa and Asia, but the Russian Army was quite another matter. British generals typically had had no actual battle experience since the defeat of Napoleon. Raglan himself had only been a very junior officer during the Napoleonic wars. This lack of experience would prove tragic, both in planning and in battle, for them and for their troops.

The British declared war on 27 March 1854, the day after the French declaration. It was expected that the allies would confront Russia in its newly annexed territories, not the Crimea. British troops were moved by sea, stopping at Malta, then camping at Scutari, a town on the Bosphorus. In June 1854 they were transferred to Varna, Bulgaria, a small town on the western Black Sea Coast. There British and French troops stayed in what was known as the Valley of the Plague. Deaths from cholera soon ensued and camp was moved. There were reports that the water had been poisoned with animal matter, placed there by the Russians.⁶ Cholera was, however, rampant in many places, and Russia could hardly be blamed for it.

A major pretext for war evaporated when Russia withdrew from the territories it had occupied in 1853. Britain and France, however, did not withdraw their troops but decided to proceed to invasion. The capture of Sebastopol, the great harbour of the Russian Black Sea fleet, became their objective, a choice that made the Crimea the seat of war. Lord Raglan was duly ordered to invade the Crimea and take Sebastopol. Any planning for such an objective, however, was woefully weak and allied intelligence on Russia’s strength almost non-existent.⁷ The allies expected that Sebastopol would fall quickly and no thought was given to wintering over.

At the end of August 1854, the allied forces, badly weakened by disease, left their camps near Varna to sail for the Crimea; 50,000 British and French troops were landed at Kalamita Bay (Calamity Bay), on the western coast of the Crimean peninsula. The Battle of the Alma, the first battle of the war, was fought on 20 September 1854, an allied victory. Balaclava, a small port, was taken on 25 October 1854.

Balaclava is the battle that receives the greatest attention in the correspondence. Infamous for the miscommunication that led to the Charge of the Light Brigade, it was celebrated in a poem by Tennyson for the nobility of those who obeyed (misinterpreted) orders and charged heavy Russian guns at enormous cost in lives. Nightingale herself quoted the poem in inspirational letters to nurses. She also quoted the French general, Bosquet, for his more apt and wry tribute: C’est magnifique, mais ce n’est pas la guerre [it’s magnificent, but it’s not war].⁸

The allied advance soon came to a halt, contrary to the expectation that Sebastopol would be taken quickly (and the men either installed there or sent back home before winter set in). Crimea has a continental climate, much colder than either Britain or France, and deficiencies in planning would soon take their toll. In fact the British would be camped before Sebastopol, as the correspondence put it, for what became a lengthy siege.

Raglan wanted to press on to attack Sebastopol but the French, under their ill commander, Marshal de Saint Arnaud, would not agree. The delay allowed the Russians to bring in more troops and build up earthen defences of the port. Their head engineer, Todleben (or Totleben) was a genius at fortifications. The allied blockade of Sebastopol was never complete, and the Russians could enter and bring in supplies until the very end.

Transportation was desperately lacking in the first months of the war. Raglan staked all on a massive invasion leading to swift capitulation. Medical equipment and supplies, water and food, warm clothing and blankets were left behind at Varna, to maximize the speed with which troops and arms could move forward. (Raglan had asked early and repeatedly for a separate, specialized land transport corps, but had been denied it.)

Even before the first battle took place, soldiers were falling ill and dying from cholera and dysentery, a point to which Nightingale would later give much attention. Even the commander-in-chief of the French Army, St Arnaud, was ill before the first battle was fought; he died nine days after it, en route back to France, having given up his command. Lord Raglan himself fell ill of fever and died in June 1855.

The sufferings of the soldiers, lack of supplies, food, water and medicines, and general mismanagement of the war, was daily fare in the British newspapers. The Times, a conservative paper, led the attack, stating that the noblest army ever sent from these shores had been sacrificed to the grossest mismanagement, incompetence, lethargy, aristocratic hauteur, official indifference … perverseness, stupidity, etc. Fresh tidings spoke of privation, sickness and death, of unspeakable suffering from neglect, of medical stores decaying at Varna that were intended for Scutari, and much more. Nightingale and her band of women nurses were specifically exempted from these charges of neglect.⁹

Despite the growing disaster, senior officials continued to fail to act upon reports from the field, which continued to report bad and worsening conditions as the winter wore on. Concerns raised in England, based on those newspaper reports and private correspondence, were often denied by the authorities in London.

The War Office and Army Medical Department

Since so much of what went wrong, in Nightingale’s view, was the result of poor administrative structure in the War Office, especially the Army Medical Department, some description of the army’s structure and functioning might be helpful.¹⁰ The British Army at the time of the Crimean War was, effectively, a collection of regiments with minimal central administration. There were two Cabinet ministers: the (senior) secretary of state for war and (junior) secretary of state at war, the duke of Newcastle and Sidney Herbert, respectively. The junior secretary position dealt chiefly with financial matters and was eliminated in 1855.

The minister(s), as civilian overseers, frequently clashed with the regular army command structure, located at the Horse Guards and referred to in short as the Horse Guards.

An enormous problem was that the Commissariat and Purveyor’s Department, responsible for providing military supplies, equipment, food and medical supplies, were not under the War Office, but Treasury. (This was later changed.) An order by the Army Medical Department to send medicine went to one department for its procurement, to another for its transportation and yet another for its landing and storage or delivery to the hospital. When they did not arrive who was to blame? Nightingale would become insistent on the need for a governor responsible for the whole process.

The director general of the Army Medical Department got much sympathy when testifying at the Roebuck committee for precisely the problem of split jurisdictions, so that he could not be held responsible for the non-supply of any essential item. Nightingale’s analyses accordingly move from causes of the high rates of disease and death to the administrative changes essential for a better system.

Similarly, while there was a central Army Medical Department in London, most doctors were based at regimental hospitals and had little to do with it. Moreover, medical officers in the field were under the authority of regular military officers, not a command structure within the Army Medical Department. They had no authority even over the orderlies in the wards. Nightingale of course was not an officer, and while she was subject to the principal medical officer, she reported (informally, but frequently and to good effect) to the junior war minister, her friend Sidney Herbert. Medical officers were entirely confined to the usual military reporting structure.

Nightingale’s belief in the decency and dignity of the ordinary soldier contrasted sharply with the views of most army officers. The common view was that they were brutes for whom drinking and prostitutes were their natural outlets. Punishments for soldiers’ offences still included flogging, which was not abolished until 1868. All Nightingale’s work to provide such amenities as coffee and reading rooms, classes and games, reflected her sense that ordinary soldiers would use them, that they were not brutes at all. She described these soldiers as moral and intellectual beings, comparing them favourably with orderlies in the Medical Staff Corps and men in the Land Transport Corps and Army Works Corps: Give them suffering, and they will bear it; give them work, and they will do it. She would rather have to do with the army generally than with any other class I have ever attempted to serve (see p 342 below). She always had some allies among the officers on this point. Nightingale also instituted measures by which soldiers could send their pay home to their families, instead of drinking it away and leaving wives and children bereft. Her views were a reflection of her radically democratic faith in general—God is no respecter of persons—and her lifelong work to provide care especially to the sick poor.

Moreover, for all their brutish treatment, British soldiers were volunteers, not conscripts. One of the reasons Nightingale gave for improving their treatment was incentives for recruitment. If more soldiers were needed, the army had to become a more attractive option. Liberal and optimistic as she was, she declared that in England, conscription will ever be impossible (see p 650 below).

Nightingale also understood the value of ordinary soldiers to the army: in effect, its essential human resource. The health of the men is the main engine of the commander, she said (see p 612 below). Death not only deprived the man and his family of his life, but the government lost an investment made in recruiting and keeping him. She cited the cost of replacing a soldier on foreign service as £100 to £120 (see p 795 below). The most economical hospital was the one that restored the greatest number of men in the shortest time to the ranks, not that with the smallest expenditure per head (see p 788 below).

The British Army did not at this time provide cooked food for soldiers but instead gave out rations. Soldiers had to cook for themselves, even to the extent of roasting green coffee, which required finding firewood and grinding the beans. Yet in Constantinople every man, woman and child had his, her or its coffee (see p 1046 below). The rations were basic, consisting almost entirely of salt meat and biscuit, entirely lacking in vegetables. As a result, the men were suffering from scurvy even before they arrived in the Crimea. The fact that excellent vegetables were the usual diet of the local population, and yet beyond the means of the army to purchase and provide, rankled: Scutari is opposite a capital of upwards of 600,000 inhabitants who live on vegetables (see p 596 below). The army’s responsibility to provide decent, cooked food would be a Nightingale preoccupation from then on. Food features much both in correspondence during the war and in her reports after it. She frequently mentioned scurvy and malnutrition, in particular in Notes on the Health of the British Army.

Soldiers’ Wives and Camp Followers

The appalling condition of soldiers’ wives and children, partners and camp followers was entirely outside Nightingale’s mandate. However, she did recruit an able volunteer to take on their care in the person of Lady Alicia Blackwood (1819-1913), wife of a voluntary chaplain at Scutari. Lady Alicia put herself to the task with vigour and generosity and accomplished a great deal.¹¹ Afterwards, Nightingale wrote an entire section in Notes on the Health of the British Army describing the rights of soldiers’ wives (such as they were) and their actual living conditions, both at war and in garrisons at home (457-76). She flagged the great suffering of the women in Bulgaria, where not one of whom had any information as to what her wants would be, or how to provide for them, nor could she, on her arrival, obtain any advice as to the present or future… . Her only theory of protection was that her regiment would never desert her, unless by general order. By tradition the privileges of their regiment gave a half ration to the soldier’s wife, plustentage; a wife could also make money by washing officers’ clothing.

Many women had followed their men to Varna. When the troops were sent on to the Crimea, however, they were not allowed to land. (Some managed to.) Many made their way back to Scutari, but since they were there illegally and without their men, there was no regulation for their provision. They appealed to Nightingale for help. A ship, the Thames, took a contingent home. Those at Scutari and environs went to odd corners in the barracks, where they lived in conditions of the worst description:

Dirty … dangerous holes in the floors, some of them dark and damp, and one or two with broken drains, admitting effluvia which produced fever… . Most lay on the floor, which was sometimes brick and sometimes earth… . The sick and the lying-in women were mingled with the rest, and among this mass the husbands took up their regular quarters.¹²

Women arriving back from the Crimea were in a state of filth, and nearly destitute of clothing, as were their sick and wounded husbands when they were brought in (465).

Nightingale employed many of the women in the washing establishment she set up after the washing contract for the hospitals had broken down. Some made clothing or nursed sick officers, for private pay. The sick and lying-in women and infants were relieved by private funds with food and clothing. A small lying-in hospital was fitted up over the washhouse in December 1854, with paid nurses. Twenty-two infants were born in January 1855 (466). Fever broke out among the women, as it did with the soldiers, and after much solicitation, a house in town was rented, repaired, cleaned, fitted up and furnished through private funds. It held some forty women, and a small school was added for the children. Nightingale paid tribute to the efficient and systematic efforts of Lady Alicia Blackwood in achieving these great reforms (467).

Nightingale duly gave recommendations to prevent such suffering from happening again, including the provision of decent accommodation for wives and children in garrisons within Britain itself. She noted that the state of the soldiers’ wives and children, even at home stations, was worse than that of people in a London alley, a point made in a report which excited universal attention. She herself had seen a casemate (a chamber in a barrack or battery) at Brompton with nine men, nine women and twenty-three children living and sleeping together, with only one door and a small window on each side, and no screening off of family space. How is it possible for the morality of the soldier to be raised while the immorality of his domestic relations is thus made inevitable? she asked.

Marriage with the soldier is, more or less, a licensed concubinage. The number of Pensioners who have more than one wife living is 2 percent, and it has been known to exist as a supposition among the soldiers, that if they marry three women, they cannot be tried for bigamy. (468-70)

Medical Science at the Time of the Crimean War

Medical science was little developed at the time of the Crimean War.¹³ Chloroform had only just come into use, and anesthetics were in general considered risky. Dr Hall, principal medical officer in the Crimea, disapproved of their use for the men, meaning ordinary soldiers, but his disapproval may not have been so much indifference to their sufferings as concern that they might die from the dose. Chloroform was a depressant of vital activity, and the men never rallied after its use, he said.¹⁴ A surgeon, James Mouat, thought that the shock of wounds was aggravated by the use of chloroform (183). The director general of the Army Medical Department, Andrew Smith, almost forbade its use entirely.¹⁵

On the other side of the debate, Sir James Y. Simpson (1811-70), a Scottish surgeon who pioneered the use of anesthetics in surgery, sent chloroform for use in the war. According to his biographer, Nightingale wrote to him asking for information on the use of chloroform in the field, and asked two individuals to supply her with the drug for free. They refused, but Simpson bought and dispatched to her 1000 doses. He in fact condemned the war and the politicians behind it.¹⁶ Nightingale is cited elsewhere as well for having provided chloroform instruments at Scutari.¹⁷ A medical historian who gave the amounts of chloroform shipped to the Crimean War for the British forces specified that there was only enough for 200 operations.

At the time of the war, antiseptic or aseptic procedures had not come into use; Joseph Lister’s pioneering antiseptic surgical procedures date only from 1865, his publications from 1867. The Barrack Hospital, in any event, had no operating theatre, as it was only a barrack given over to hospital use for the war. Nightingale had screens put up for some privacy in operations, which must have been brutal affairs. The death rate for amputations was roughly 50 percent. Hand-washing, the most basic form of hygiene, was ignored. British soldiers even broke off the water taps in the privies (Turkish soldiers did wash, hence the provision of running water.) Soap was not provided until late January 1855, when the order was given that men were to be compelled to wash themselves two or three times a week at least (see p 596 below). Nightingale, however, stressed how much the men had been begging for soap and a wash basin before then.

The great bowel diseases that killed and weakened so many men during the war were cholera (identified only in 1883), diarrhea (in 1885) and dysentery (in 1898). A cholera epidemic in London earlier in 1854 was stopped when Dr John Snow closed off the tap at a public water pump he identified as the source of the contaminated water. However, he did not convince the medical profession that he had identified the cause of cholera itself. There was no realization then that cholera is transmitted by foul water, and virtually no attention was paid to the bad water prevalent in the camps.

The great killing fevers of the Crimean War were all identified not by their bacillus, but by their symptoms, such as low, continued, remittent and intermittent fevers. Typhoid fever was identified in 1880. Nightingale’s own fever disease was likely brucellosis, which was not identified until 1887 (by Australian-born microbiologist, David Bruce), yellow fever not until 1900. Germ theory is considered to have been given its definitive statement in Robert Koch’s 1879 The Etiology of Traumatic Infectious Diseases. Nightingale’s strenuous measures for cleanliness were clearly pre-germ theory.

Effective medicines at the time were still rare—opium and quinine are the most mentioned. What would have helped the most in fever epidemics—antibiotics—did not come into use for roughly another century. Doctors’ orders consisted largely of what stimulants to use (brandy, port wine or champagne) and food, prescribing extra diets, of which there were several varieties.

Clean sheets and clothes were simply not provided at all, nor was this lack seen as important until Nightingale got a functioning laundry going. Ordinary soldiers were assumed not to be so fastidious as to want clean clothes, and the fact that dirty bedclothes and clothing could actually reinfect a patient, causing further disease, was simply not understood.

That some officers were not pleased with Nightingale’s insistence on cleanliness and order is clear in the surviving correspondence. Major Francis Beckford Ward, Royal Horse Artillery, wrote his parents that Miss Nightingale is here again and I understand that she threatens to pay a visit to my hospital during the present week.¹⁸

Cholera belts are mentioned occasionally in reports and correspondence. They consisted of a flannel bandage wrapped around the abdomen, and were considered to offer some protection against the disease, but not to be a cure. Europeans sweated a lot in hot climates and the belt kept them from remaining damp from sweat when the temperature dropped at night. Respected doctors such as James McGrigor, William Aitken and E.A. Parkes, for example, advocated their use, and they continued to be provided even late in the nineteenth century. The issuing of cholera belts with the benefit of hindsight seems quite an anachronism.

Nightingale frequently referred to zymotic disease in Notes in the Health of the British Army and Answers, and occasionally in correspondence. The term was connected to a new concept of disease, dating only from 1842, from the Greek for causing fermentation. The concept can be seen as a step on the way to germ theory, as it posited a living process, fermentation, as the cause of the disease, although not a specific bacillus. Nightingale’s point was always that those diseases considered zymotic—scurvy, cholera, diarrhea, dysentery and fevers—were preventible. Consumption and chest diseases were not considered zymotic. For zymotic diseases the medical officer should ascertain their causes when they appeared, whether drainage, overcrowding or other problems. These reports would then be sent to the commanding officer, and were to include remedial measures and to note progress of the disease. In Notes on the Health of the British Army, Nightingale said that zymotic diseases were no less than the cause of the whole catastrophe (see p 879 below). She continued to use the term in reports in the 1860s, but not later than that. While the theory was incorrect, the point of the concept was the possibility of the prevention, or at least the mitigation, of disease. The hows of disease and its prevention, not the whys, ultimately were her focus and goal.

Finally, we must consider the boldness of Nightingale’s ambition for nursing. She, in effect, brought an entirely new kind of professional into army hospitals, and women, no less (not forgetting that many of them were not, in fact, qualified). Women had been employed under the name of nurse earlier in the nineteenth century, in both regimental and general army hospitals, but they were in no sense the trained nurses Nightingale sought to establish. These nurses were the equivalent of orderlies, recruited from among the wives of non-commissioned officers and privates. They held the status of a private, reported to a sergeant, and were paid less than washerwomen and cooks.¹⁹ Their employment was not considered successful and was discontinued.

Lord Raglan, John Hall and Andrew Smith

The three most important people Nightingale worked under were the commander-in-chief, Lord Raglan (1788-1855), the principal medical officer, Dr (later Sir) John Hall (1815-66), and the director general of the Army Medical Department in London, Dr (later Sir) Andrew Smith (1797-1872). Her relationship with each was quite different, and only that with Raglan was at all satisfactory in her terms. Raglan had appointed Smith, and Smith appointed Hall, mistakes both, in Nightingale’s view. To Sidney Herbert she condemned the appointment of Andrew Smith: Never was there a more fatal act. It lost him his army and his reputation (see p 551 below). Lord Raglan, commander of the British forces, was sixty-five at the time of the war, and had never led troops in the field. He had been wounded with the duke of Wellington, when he famously bore the amputation of an arm on the spot, from which the raglan sleeve. He served as the duke of Wellington’s military secretary from 1810 to 1852. Raglan was gracious to Nightingale (both sides of their correspondence is available) and she would later defend him.

Lord Raglan’s strained relations with his French allies are clear throughout in correspondence and reports. For him, it must be remembered, the French were the enemy the last time they met in combat, at Waterloo, and he is known to have referred to them as the enemy. He died of fever in June 1855—some said he died of despair, others of the Times, for he had come to be the scapegoat for the failures of the army. Nightingale loved him for his kind and gentle courtesy. She recalled him as a good man taken away before the evil to come, yet few perhaps could have done worse for us than he has done (see p 197 below).

As the last line above indicates, Nightingale’s considered view of Lord Raglan was more negative than anything she ever published would suggest, at least in part due to the propriety of not speaking ill of the dead. In Notes on the Health of the British Army, she made much of his general orders, in May 1854, in favour of sanitary precautions (see p 610 below). But the orders were not followed in practice, and certainly were never adequately fleshed out with specifics. Lord Raglan at times seemed to be acting as his own sanitary officer, and even as his own detective in tracking down missing supplies. Nightingale did not consider this a safe system. These remarks were ostensibly a criticism of the Army Medical Department, but she also acknowledged that Raglan never called for detailed plans. Without mentioning his name, Nightingale noted in a section entitled General Defects of Procedure that the Army Medical Department appeared never to have been consulted about rations, clothing or sanitary measures (see p 886 below). For most of the points on that list of defects, however, she laid the fault squarely on the department for its failure to give adequate instructions.

Many of Nightingale’s comments exonerate Lord Raglan. She quoted Lord Hardinge’s testimony that he could not have known what was going on in the hospitals at Scutari—he was in the field 300 miles away, and any suspicions he might have had as to wrongs would have been corrected by Dr Hall’s report of flourishing conditions (see p 642 below).

On return from the war, in a letter to Sidney Herbert, Nightingale called Raglan a most chivalrous and noble old man in his disregard of mere public opinion (see p 463 below). She nevertheless agreed with Herbert’s critique, but thought it would be ungenerous and untrue to attack him, who is gone, while those who misinformed and misled him have all been promoted and rewarded for the very acts for which he is blamed (see p 518 below).