Civilian Assistance to the War Wounded
The word ambulance itself first appeared in French and in English around 1819, but did not come into general use until the Crimean War. The evolution of "ambulance service" then took place in the context of the terrible carnage of the battlefields of Europe and America in the second half of the 19th century. In 1854-1855, during the Crimean War, an extraordinary English woman, "the lady with the lamp", founded the myth of the modern nurse, a heroic individual dressed in white, not black, bearing the symbol of the red cross, not the crucifix, of professional and not of religious, vocation.
On the other side, Miss Florence Nightingale, who was familiar with the hospitals in England and with the principal charitable and philanthropic establishments on the Continent, and who had given up the pleasures of opulence in order to devote herself to doing good, received a pressing appeal from Lord Sidney Herbert, Secretary at War of the British Empire, asking her to go and look after the English soldiers in the Near East. Miss Nightingale, who has attained a great popularity, did not hesitate in undertaking this fine work, with which she knew that her Sovereign sympathised. She left for Constantinople and Scutari in November, 1854, with thirty-seven English ladies, who, as soon as they arrived, set to work caring for the many wounded of the battle of Inkermann. In 1855, Miss Stanley joined her with fifty others, and this enabled Miss Nightingale to go to Balaclava and inspect the hospitals there. All that she accomplished during those long months of sublime self-sacrifice, through her passionate devotion to suffering humanity, is well known.
__ Henry Dunant, A Memory of Solferino, (1862), [English translation]
Reports were soon reaching London, in the despatches of The Times' correspondent, William Howard Russell, of atrocious conditions in the British hospitals. Cholera, dysentery and gangrene spread among wounded soldiers for whom there was a totally inadequate, inefficient and ill-prepared medical service. The team of men designated to carry the wounded from the battlefield were lazy, drunk and incompetent. The barracks hospital at Scutari, a former Turkish military hospital taken over by the British in May, was filthy, damp and infested with vermin. 'The manner in which the sick and wounded are treated is worthy only of the savages of Dahomey,' wrote Russell in one of his despatches home. The Inspector General of Hospitals, Dr John Hall, was not keen on anaesthetics, cautioning his medical officers against the use of chloroform in cases of severe gunshot wounds: 'however barbarous it may appear,' he told them, 'the smart of the knife is a powerful stimulant; and it is better to hear a man bawl lustily, than to see him sink silently into the grave.'
The French, Russell observed, were in fact coping rather better with their wounded and sick soldiers, and had already sent fifty admirable sisters of charity to help with the nursing. Sidney Herbert, Secretary at War, wrote to Florence Nightingale (who had run a sanatorium in London) asking her whether she might be willing to recruit and supervise a group of British nurses in the Crimea. Early in November, accompanied by twenty-four carefully selected women, she reached the barracks hospital.
Four miles of sick and wounded men lay on beds and palliasses down the wards and along the corridors. The smell, from dead rats under the floorboards and blocked and overflowing sewers, was overwhelming. There were no brooms or brushes to sweep up the dirt and rubbish, and very little water. Men, clothes and blankets were filthy and covered in blood, and the men themselves plagued by fleas, lice, bugs and maggots. There were no spoons, bowls, plates, scissors, knives or towels. It was, Florence Nightingale reported, a 'calamity unparalleled in the history of calamity'. She summoned a thousand mops, fifty quart bottles of disinfectant, three thousand tin plates and two thousand yards of towelling and put her nurses to work. She was not altogether popular. But within an amazingly short time, she had installed boilers with which to wash the filthy clothes and linen; introduced special diets that the wounded and sick men could actually eat; reorganized the kitchens; imposed order on chaos and misery. The hospital became clean, efficient and relatively comfortable.
From superintendent of female nurses, Florence Nightingale turned into a quartermaster for the army, using money raised by herself and through The Times Fund to buy clothes, food, clocks, operating tables, nightcaps, buckets, bedpans, candlesticks, shoebrushes and port wine. The wounded and sick were brought in dressed in rags; they left the hospital with clean clothes, drinking cups and knives and forks. By the time the war ended, the barracks hospital had two recreation rooms with maps, prints, newspapers and writing paper, and four schools in which convalescents could learn to read and write. And women nurses had been introduced into military hospitals. Florence Nightingale had ensured that there would be a future in nursing for respectable women, as long as they were, as she wrote, 'sober, honest, truthful, trustworthy, punctual, quiet and orderly, cleanly and neat'. She had no time for 'excellent gentlewomen more fit for Heaven than a hospital'. What was more, she had managed to reduce the deaths from sickness dramatically. During the second winter of the campaign, after the fall of Sebastopol, the French lost 21,191 men through sickness, the British only 606.
__ Caroline Moorehead. Dunant's Dream. Carroll & Graf, New York. 1998.
Cecil Woodham-Smith, Florence Nightingale, New York, 1951.
"Two figures emerged from the Crimea as heroic, the soldier and the nurse. In each case a transformation in public estimation took place, and in each case the transformation was due to Miss Nightingale. Never again was the British soldier to be ranked as a drunken brute, the scum of the earth. He was now a symbol of courage, loyalty, and endurance, not a disgrace but a source of pride. "She taught officers and officials to treat the soldiers as Christian men." Never again would the picture of a nurse be a tipsy, promiscuous harridan. Miss Nightingale had stamped the profession of nurse with her own image. Jane Evans and her buffalo calf, Mother Bridgeman and her proselytizing, Mary Stanley's ladies and their gentility, the hired nurses and their gin have faded from history. The nurse who emerged from the Crimea, strong and pitiful, controlled in the face of suffering, unself-seeking, superior to considerations of class or sex, was Miss Nightingale herself. She ended the Crimean War obsessed by a sense of failure. In fact, in the midst of the muddle and the filth, the agony and the defeats, she had brought about a revolution."
William H. Taft (ed.) Service with Fighting Men, New York, 1922.
"The work of Florence Nightingale in the British Army during the Crimean War is rightly regarded as marking a turning-point in human experience. To gain a just comprehension of what she accomplished her whole career must be surveyed."
Mabel T. Boardman, Under the Red Cross Flag at Home and Abroad, Philadelphia: J.B. Lippincott, 1915.
"But new and forceful factors were soon to lead to a remarkable change in conditions. These factors were the telegraph and the press. The majority of those who witnessed the horrors of the battlefield were they who had taken part in the struggle and accepted conditions as the grim and terrible fate of war. Not so, though, was it with those at home, to whom the telegraph, through the daily press, brought the story of the misery, the agony of the thousands of wounded, for they saw among the suffering men some husband, father, brother, son or other dear one of their own."
Raymond Herbert. Florence Nightingale: Saint, Reformer or Rebel?. Malabar, FL: Krieger, 1981.
"It is this more multi-faceted woman, then, that emerges from the pages that follow. She was the powerful force who not only brought reform and improvements to nursing and nursing education but also to more far-reaching fields such as the army and medicine, public health, governmental legislation, statistics and especially the status of women. This is the impact expressed by Cook when he coined the phrase "Nightingale Power," meaning "Opportunity, Industry, Mental Grasp and Strength of Will." Or, by Woodham-Smith, when she concluded that "in the midst of the muddle and the filth, the agony and the defeats, she had brought about a revolution." Her greatest memorial, then, was clearly and appropriately her work---a realization best described by Stephen Paget for posterity in his Dictionary of National Biography article:
Miss Nightingale raised the art of nursing in this country from a menial employment to an honoured vocation, she taught nurses to be ladies, and she brought ladies out of the bondage of idleness to be nurses. This, which was the aim of her life, was no fruit of her Crimean experience, although that experience enabled her to give effect to her purpose than were otherwise possible. Long before she went to the Crimea she felt deeply the "disgraceful antithesis" between Mrs. Gamp and a sister of mercy. The picture of her at Scutari is of a strong-willed, strong-nerved energetic woman, gentle and pitiful to the wounded, but always masterful among those with whom she worked. After the war she worked with no less zeal or resolution, and realized many of her early dreams. She was not only the reformer of nursing but a leader of women."
General Sir Edward Hamley, The War in the Crimea, London: Seeley&Co., 1900.
"Those who were children at the time of the Crimean War can scarcely realise how ardent, how anxious, how absorbing was the interest which the nation felt for the actors in that distant field..."