Florence Nightingale had a similar administrative drive to the Grand Duchess. Born into a family of successful industrialists in Derbyshire, she was better educated than most of the men in the British government, among whom her family had a number of connections, though because of her sex she was forced to limit her activities to the field of philanthropy. Inspired by her Christian faith, she entered nursing at the age of 25, much against the will of her family, working first as a social reformer among the poor and then in a Lutheran religious community at Kaiserswerth-am-Rhein near Düsseldorf in Germany, where she observed Pastor Theodor Fliedner and his deaconnesses care for the sick. Graduating from Kaiserswerth in 1851, Nightingale brought back its principles of nursing to the hospital in Harley Street, where she took over as superintendent in August 1853. It was these principles – basic cleanliness and good housekeeping on the wards – that Nightingale would take to the Crimea. There was nothing new in her ideas. The British medical officers in the Crimea were well aware of the benefits of hygiene and good order in the hospital. Their main problem in turning these commonsense ideals into active policies was a lack of manpower and resources – a problem Nightingale would only partly overcome.
In his capacity of Secretary at War, Herbert appointed Nightingale as superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey, though not in the Crimea, where she had no authority until the spring of 1856, when the war was almost at an end. Nightingale’s position was precarious: officially she was subordinated to the military hierarchy, but Herbert gave her instructions to report to him on the failures of the Army Medical Department, and her whole career would depend on fighting tooth and nail against its bureaucracy, which was basically opposed to female nurses at or near the front. Nightingale was domineering by nature but she needed to assume a dictatorial control over her nurses if she was to implement her organizational changes and gain the respect of the military establishment. There was no recognized body of professional nurses from which she could draw her team in Turkey, so with the help of Mrs Herbert she had to establish one herself. Her selection criteria were ruthlessly functional: she favoured younger women from the lower classes, who she thought would buckle down to the hard work and conditions that lay ahead; and she took a group of nuns with experience of nursing to supervise their work, regarding them as a practical concession to the Irish Catholics who made up one-third of the army’s rank and file; but she rejected hundreds of applications from well-meaning middle-class women, whose sensitivities she feared would make them ‘less manageable’.
Nightingale and her team of thirty-eight nurses arrived in Scutari on 4 November 1854, just in time for the mass transport of the wounded from the battle of Balaklava. The French had already taken over the best buildings for their hospitals, and those left for the British were badly overcrowded and in a dreadful state. The wounded and the dying were lying all together with the sick and the diseased on beds and mattresses crammed together on the filthy floor. With so many men suffering from diarrhoea, the only toilet facilities were large wooden tubs standing in the wards and corridors. There was almost no water, the old pipes having broken down, and the heating system did not work. Within days of Nightingale’s arrival, the situation became much worse, as hundreds more wounded men from the battle of Inkerman flooded the hospital. The condition of these men was ‘truly deplorable’, as Walter Bellew, an assistant surgeon at the Hyder Pasha Hospital near Scutari, noted in his diary: ‘Many were landed dead, several died on the way to the hospitals, and the rest were all in a most pitiable condition; their clothes were begrimed with filth and alvine evacuations [from the abdomen], their hands and faces blackened with gunpowder & mud &c and their bodies literally alive with vermin.’ The men were dying at a rate of fifty to sixty every day: as soon as one man breathed his last he was sewn into his blanket and buried in a mass grave by the hospital while another patient took his bed. The nurses worked around the clock to feed and wash the men, give them medicines, and bring them comfort as they died. Many of the nurses were unable to cope with the strain and began drinking heavily, some of them complaining about the bossy manner of Miss Nightingale and about their menial work. They were sent home by Nightingale.28
