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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.

Carol Helmstadter

Pirogov and the other principal surgeon, Christian Hübbenet, soon became highly dependent on the Sisters because they were so much more competent than the untrained local women. Pirogov divided the Sisters into three groups, surgical nurses, pharmacists, and housekeepers, and placed them in charge of hospital administration. He also introduced his famous triage, saving many more lives. Hard work and typhus soon decimated the Sisters and a number died. By early spring many doctors, including Pirogov, also fell ill and some died. A major problem now developed among the Sisters. They played mean tricks on each other and there was a great deal of infighting which Pirogov and the senior Sisters were unable to stop. Constant trench warfare, the sorties that the Russians sent into the allied trenches, and the increasingly lethal allied bombardment kept the Sisters and doctors working under fire at an inhuman pace. Pirogov and Hübbenet were amazed by the Sisters’ selflessness and their courage and coolness under direct fire, which the doctors at first thought quite uncharacteristic of women. Pirogov now taught the able nurses to do specific medical procedures, some of which Hübbenet thought they did better than the doctors.

in Beyond Nightingale
Carol Helmstadter

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
Carol Helmstadter

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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Pirogov and the Grand Duchess
Carol Helmstadter

This chapter is developed in the context of the Russian army, which was deeply permeated with corruption and graft. It was essentially an eighteenth-century army in the 1850s, fighting industrialized countries. The soldiers were basically all serfs; in the officer corps there were dramatic contrasts between ignorance and incompetence at one end and intelligence, energy, and cosmopolitan professionalism at the other. This was also true of the medical department and its nurses, the ‘feldshers.’ The internationally renowned surgeon Nikolai Ivanovitch Pirogov, who became director of the nursing service, is introduced, as is the widowed sister-in-law of the Tsar, Grand Duchess Elena Pavlovna, his patron at the imperial court. She had the daring idea of sending female nurses to work on the battlefield. Together these two individuals established the Sisters of the Exaltation of the Cross, a lay sisterhood of clinically trained nurses devoted entirely to military nursing. Local women had come forward to help with the nursing, but once the trained Sisters arrived they were so superior that the local women were relegated to minor roles. On arrival in the Crimea, Pirogov immediately began organizing and vastly improving the hospitals.

in Beyond Nightingale
Carol Helmstadter

The south side of the city fell to the allies on 8 September 1855, making the tented hospitals outside the north side of the city at Belbek and the Inkerman Heights the principal Russian hospitals. Pirogov and a number of doctors, utterly exhausted, left Sevastopol just before the south side fell, but Pirogov returned in August to find head nurse Stakhovich personally in charge of the tented hospitals and doing a very poor job. He discovered that she was responsible for all the infighting among the Sisters. The Grand Duchess replaced her with Ekaterina Khitrovo, who was an immense success. Because there was now little fighting Pirogov reorganized the nursing, creating a team of Sisters who accompanied soldiers being evacuated to convalescent hospitals in Perekop and on the mainland. Pirogov met every night with the senior Sisters and their chaplain to develop nursing policies. He envisioned a somewhat similar committee running military hospitals after the war. The Sisters’ capabilities are discussed in the context of the social and legal position of Russian ladies. Their superb competencies changed the doctors’ view of women. Pirogov now believed women were equally competent as men when given the same opportunities for education.

in Beyond Nightingale
An absence of trained nurses and basic resources
Carol Helmstadter

The Ottoman Empire was far more backward than the Russian. Furthermore, there appears to be no information in the Turkish archives on the Crimean army’s medical department. Two British observers, Humphry Sandwith, who was a surgeon in the Ottoman army during the war, and Adolphus Slade, who was administrative head of the Ottoman navy from 1849 to 1866, provide most of the information we have about the Ottoman medical service. There seems to have been no effort to organize a nursing service. The commissariat supplied the medical service very badly, while the doctors were poorly trained and the orderlies totally untrained. Nevertheless, these doctors were anxious to learn and, equally important, they enthusiastically and devotedly cared for the Ottoman soldiers with their limited resources, giving them any nursing care they could and treating Russian prisoners with equal zeal.

in Beyond Nightingale
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Transcending the limitations of gender
Carol Helmstadter

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
Carol Helmstadter

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
Carol Helmstadter

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