History

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Myth and reality
Carol Helmstadter

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
Carol Helmstadter

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
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

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
Carol Helmstadter

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
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
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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

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
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
Carol Helmstadter

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