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Nursing on the Crimean War battlefields

This book is a study of nursing in the five Crimean War armies. It sets military nursing into the wider transnational context, and studies the political and economic as well as the cultural and military factors which impacted the early development of modern nursing. In the Ottoman army there was no nursing corps as such, so doctors gave whatever nursing care their soldiers received. In the other four armies three systems of nursing developed: government-directed, doctor-directed, and religious sisterhood-directed. Government-directed nursing, the system in which Nightingale worked, was the most difficult to apply and placed the most constraints on the nursing superintendent. Religious sisters were highly successful, as were the trained French and Sardinian soldier nurses who reported to them, but the most innovative and productive military nursing developed in a doctor-directed nursing service, that of the Russians. There the director of nursing was a brilliant, internationally renowned Russian surgeon, Nikolai Ivanovitch Pirogov. As well as giving his nurses a wide scope of practice, he placed them in charge of hospital administration. Nursing under direct fire for most of the siege of Sevastopol, the Russian nurses met the challenges brilliantly. The book concludes that French and Sardinian soldier nurses, the Daughters of Charity, and Russian nurses provided the best nursing because they worked on the battlefields where they could save the most lives, while British nurses remained confined in base hospitals.

This chapter describes the decentralized and inefficient administration of the British army medical department. The department was a civilian, rather than a military department, which meant the doctors had no authority over their patients and orderlies and could only make recommendations to the military High Command. The position of hospital nurses in the British hierarchical class structure placed them at the very bottom; they were very much looked down upon, while their social behavior sometimes merited censure. This made it especially difficult to introduce them into army hospitals. The ideology of the domestic and public spheres in Victorian society, and how this affected the lady nurses, is explored in the chapter. Furthermore, it explains how Nightingale, who saw her government-directed mission to the East as a mystical religious commitment, was placed under severe political constraints. She had to accept women whom she considered unqualified, and 25 percent of the nurses had to be Roman Catholic at a time when anti-Catholicism was rampant. The chapter also describes the impossible situation of the orderlies, who were the principal nurses.

in Beyond Nightingale

The British government established two hospitals in Turkey, in Smyrna and Renkioi. Civilian, rather than army doctors directed the hospitals and the nursing. The doctors ran the hospitals on the model of the civilian hospitals they had worked in at home. Two secular ladies, Henrietta LeMesurier at Smyrna and Maria Parkes at Renkioi, neither of whom had any experience in clinical nursing, became outstanding lady superintendents. Both did extremely well, with a good deal less firing of nurses compared to Nightingale and her lady superintendents. The Smyrna hospital was housed in a dilapidated building very similar to the Barrack Hospital but the Renkioi hospital was purpose-built, designed by Isambard Brunel, and incorporated all the latest features that the sanitarians demanded. In the Renkioi hospital, with the exception of Lady Superintendent Maria Parkes who was the sister of the director of the hospital, the lady nurses were paid. Ladies were no longer volunteering unless they were paid, a major shift in the Victorian concept of the domestic sphere. At the same time the doctors’ belief in women’s mission impeded innovation in nursing in these hospitals.

in Beyond Nightingale
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Transcending the limitations of gender

The highly politicized government-imposed system of nursing was the hardest to apply; Florence Nightingale faced the greatest challenge of any of the nursing directors and did well under the circumstances. As a whole, the religious nursing sisterhoods consistently provided the best nursing, but it was doctor-directed nursing in Russia that developed the most innovative and efficient system. The Crimean War demonstrated that nursing was becoming a knowledge-based practice. The barely literate British working-class nurses were aware of this and demanded recognition of their expertise and body of knowledge, but a persistent theme in the story of nurses is the way the upper classes looked down on them and what they considered their menial and repulsive domestic service. The most outstanding feature of the war’s nursing experience was the transnational humanitarianism of nurses who came from all classes and such different cultural backgrounds. Despite all the restrictions and obstacles these men and women faced, all managed to relieve some of the sufferings of their patients. However, the nursing services which were most successful, the Russian, French, and Piedmont-Sardinian, were those in which the nurses transcended gendered constructions, and their competencies rather than their sex determined their roles.

in Beyond Nightingale

As professionally trained nurses, the Daughters of Charity had a long tradition of managing French military base hospitals, which they did extremely effectively; their patients took a very positive view of their work. The French medical department functioned very efficiently at the beginning of the war because it included professionally trained soldier nurses as well as canteen ladies, who were essentially sutlers and entrepreneurs but who also gave care on the battlefield. The trained soldier nurses were excellent but the doctors always complained there were not enough of them. Furthermore, these nurses could not advance beyond the level of non-commissioned officer. The French had solved the problem of land transport for the wounded and sick with their muleteers, but the medical department’s administrative arrangements were unsatisfactory. It reported to the commissariat which did not consider the care of the sick and wounded a high priority. In a good example of transnationalism, the Piedmont-Sardinians modeled their army on the French and similarly had trained male soldier nurses. Their nursing system was somewhat better because their soldier nurses could become officers and their Daughters of Charity worked on the battlefield. They had an outstanding leader in the Countess Cordero.

in Beyond Nightingale

Because of the skilful and very effective Russian defense, the French had to keep enlarging their army; the French did not have the financial resources of the British and became unable to supply the larger army properly. The commissariat’s failure to send items such as pressed vegetables led to the outbreak of scurvy and other diseases. Following the fall of Sevastopol on 8 September 1855 many of the doctors and the trained soldier nurses died of disease, and in December typhus completely overwhelmed the medical service. Many nurses died and were replaced with commandeered soldiers who lacked the zeal and aptitude of the trained men. Nevertheless, the doctors and soldier nurses managed to give the same generous efficacious care to Russian prisoners as well as to their own men. The French, following the Russian example, trained the better educated and more talented convalescents and soldier nurses to do a number of medical procedures, which the chief doctor thought saved the department from total collapse. The winter of 1855–56 was a total reversal of the previous winter when the French were well supplied and the British were starving.

in Beyond Nightingale
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The introduction sets out the aim of the book: to set the nursing in the five Crimean War armies into the wider context of the different countries’ military, cultural, political, and economic structures. It describes the imperialist causes of the Crimean War and the war aims of each country, as well as explaining why the book is limited to the Crimean campaign when the war was fought in so many other places. The introduction then indicates how these imperial aims did not have any impact on the nursing. It also explains that the book is organized by systems of nursing rather than by nationalities because the subject matter is transnational.

in Beyond Nightingale
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Myth and reality

This chapter demonstrates that the widespread belief that the upper-class lady nurses in Nightingale’s team rapidly revolutionized nursing is a myth. It explores the Victorian gendered construction of ladies and contrasts this unrealistic depiction of upper-class women with nursing efficiency. The controversial role of Mary Stanley is analyzed in detail. Only one of the fifty secular lady nurses who volunteered was able to nurse clinically, while the trained religious nursing Sisters excelled. As well as being first class nurses, they had more stamina; proportionately more religious Sisters worked through the whole twenty-month campaign than any of the secular ladies or working-class nurses. Still, Nightingale saw the working-class nurses as the most useful. She considered the secular ladies’ work to be raising the characters of the working-class nurses rather than patient care. The chapter also explores the shift in the concept of woman’s mission. Most of the fifty lady nurses were not paid a salary, as befitted the earlier idea of a lady, but by the end of the war twelve ladies were paid salaries.

in Beyond Nightingale

The work of the controversial and formidable Mother Francis Bridgeman and her fourteen Sisters of Mercy is discussed in the context of anti-Catholicism and the Irish Question. Nightingale met stolid resistance from Bridgeman from the very first time she encountered her. She tried desperately to win Bridgeman’s confidence because of the important political consequences which would ensue if Bridgeman and her nuns were to abandon the Eastern hospitals, but she never succeeded. Bridgeman felt strongly that her system of nursing differed radically from that of Nightingale. The chapter explores her view of the two systems of nursing in detail, and demonstrates that to a large extent she misrepresented Nightingale’s nursing services while Nightingale exaggerated the untidy state in which she found the Balaclava General Hospital when Bridgeman left. This chapter also demonstrates that Bridgeman did not take a transnational approach to nursing; rather she felt her Sisters were only able to do their best when they had recreated Irish conventual practice in Balaclava.

in Beyond Nightingale

This chapter discusses nursing in the naval hospital in the context of the new medicine’s need for expanded and much more expensive resources and the social determinants of health. The navy took much better care of its men, resulting in their being able to recover faster and better than the soldiers whose officers gave them little support. The Naval Brigade which fought on land with the Royal Artillery was a crack unit which distinguished itself both for bravery and for the accuracy of its guns. Dr. John Dawson directed the nursing service, which was run by secular lady nurses with the help of a number of working-class hospital nurses. The able Lady Superintendent Eliza Mackenzie was fortunate in her three lady nurses, two of whom were experienced clinical nurses. Motherly nursing care, which the Victorians believed to be the best possible nursing care, is explored in the example of a mother who came to Scutari to personally nurse her wounded son, Midshipman Evelyn Wood. The chapter also analyzes the work of Nurse Ruth Dawson, and why Nightingale thought her one of her best nurses.

in Beyond Nightingale