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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.

British military nursing in the Crimean War

In the Crimean War four different combatants, Britain, France, Sardinia and the Ottoman Empire fought Russia on two continents in many locations but, because it is so well documented, this chapter deals with British nursing on the Black Sea littoral. It explores the importance of nursing knowledge in the mid-nineteenth century context of a different understanding of disease and a different construction of women's role in a society that was becoming increasingly defined by social class. Moral disorder or 'lack of order and regularity', as the Victorians sometimes put it, was not limited to these peripheral institutions but permeated society as a whole. The new medicine required reliable, clinically experienced nurses who could take responsibility for critically ill patients and carry out medical orders intelligently and with good judgement. Patient care was based on a different understanding of disease and its causation.

in One hundred years of wartime nursing practices, 1854–1953
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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

This chapter discusses the nature of the Crimean War, a war which incorporated much of the old eighteenth-century style of warfare, especially on the Russian side, but on the allied side saw the beginnings of twentieth-century industrialized total war. It demonstrates why this put the Russians, whose agrarian economy was based on serf labor, at an exponentially greater disadvantage, placing added burdens on the Russian nurses. In the Russian and Ottoman empires there had been little social change since the Napoleonic Wars, but the industrial revolution had produced significant changes in Britain, France, and Piedmont-Sardinia. At the same time, in these three countries a humanitarian movement was developing, and the populations were more literate and better able to put pressure on their governments, thus politicizing diplomacy and war service. The chapter explains the very major differences between military and civilian patients. It also includes an outline of the war as seen by a veteran soldier, and details the status of medicine and nursing in the 1850s.

in Beyond Nightingale

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

This chapter explores the work of the Anglican Sisters and the second team of Sisters of Mercy in the context of the woman’s movement and the many new sisterhoods founded throughout Europe in the nineteenth century. Sisterhoods provided an important channel for nineteenth-century ladies to find interesting and challenging work without compromising their social status by accepting a salary. Secular ladies could do volunteer social service and nursing part-time because such work was considered traditional Christian philanthropy, but as religious Sisters they could work full-time and have a real career. This was a major drawing card and attracted many able women who wanted to make better use of their talents. The Bermondsey (London) Sisters of Mercy were expert trained nurses whose exceptional Mother Superior, Mary Clare Moore, took a very different approach to nursing in the East from that of Mother Francis Bridgeman. Moore became one of Nightingale’s principal supporters and a close personal friend. Anglican sisterhoods, dissolved during the Reformation, started to be refounded only in the late 1840s, so there were fewer of them. Still, of the ten Anglican Sisters who nursed in the war, five proved to be outstanding nurses.

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

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

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

This chapter analyzes Nightingale’s problems in the East: the resistance of many doctors and army officers, directing nurses in hospitals which were hundreds of miles apart in Turkey and Russia, and establishing discipline among the disparate group of women who volunteered as nurses. The myths that Nightingale effected all her improvements with only thirty-eight nurses and that she directed the nursing in all the military hospitals are set straight. The working-class nurses, who had the clinical experience essential for their work, often lacked respectability; by mid-January 1855 Nightingale had dismissed eight of the fourteen in her original party. She believed nursing systems should align with the earlier Victorian class structure. The Victorian ideology of separate spheres for men and women also made her job more difficult. Nightingale was confined to base hospitals, while the War Department’s orders severely constrained her: first, she was always to strictly follow doctors’ orders and military regulations which required, among other things, getting every requisition signed by two doctors; and second, she was to prevent religious sectarian quarrelling.

in Beyond Nightingale