Establishing Professional Nursing in British Army Hospitals

Jane Shaw Stewart: Introduction

Jane Shaw Stewart (ca. 1821-1905) was a member of the Scottish nobility, sister of the seventh baronet, Sir Michael Shaw Stewart. She was part of the second group of nurses to arrive in the Crimean War in December 1854 and proved herself to Nightingale both as a nurse and administrator. She was superintendent of nursing at the Castle Hospital at Balaclava in 1855. Like Nightingale, she served as a “lady,” receiving no salary for her 52 weeks service (report to Lady Canning  in 14:290); she also insisted on paying her own travel expenses.   Nightingale praised her devotion, unselfish, consistent looking to the great end,” the work as a whole, not just her. She had “untiring zeal” exercised “watchful care of the nurses,” her “accuracy in all trusts and accounts” (testimonial for Lady Canning, end 1855  West Yorkshire Archive Service, Leeds Canning 177/2/3, in 14:294).

Post-Crimea, Nightingale did much to promote Shaw Stewart’s career beginning by making introductions for her in French hospitals. Shaw Stewart sent her letters from the model, civilian hospital, Lariboisière, the ancient Hŏtel-Dieu, both in Paris, and the military Salpetrière, Vincennes and Val de Grăce. She also made visits to Vienna and to the Bethanien Institution in Hamburg.

Nightingale recommended that Shaw Stewart be made superintendent of nursing at the Woolwich Hospital in 1861 and then at the Royal Victoria Hospital, Netley, when it opened in 1863.  She was not only the best superintendent Nightingale had had during the Crimean War, but the only person she thought could head the nursing at a peacetime army hospital.

A full volume of letters and notes by Shaw Stewart survives (Add Mss 45774), but which are very hard to read. These include her reports on French hospitals. A serious complication in relating her contribution, Shaw Stewart burnt Nightingale’s letters to her, as confidential.

Nightingale depended on Shaw Stewart and thought highly of her judgment. She appears here with wildly opposite qualities: competence, integrity, snobbery and temper. Getting professional nursing started, both military and civilian, involved setbacks and crises. Shaw Stewart had been exemplary as superintendent during the Crimean War, very unsatisfactory later. Her high breeding became a problem in real life, for she declined an invitation to tea with the commandant of Netley Hospital, General Wilbraham and his wife, at their home. Shaw Stewart was a member of the nobility, Wilbraham a mere general. One can imagine what Nightingale must have thought of the refusal, but she could not see this as grounds for dismissal (see further in 15:146-47, 159-61, 176-79).

The Shaw Stewart family itself had its eccentricities, to say the least. Nightingale passed on to Sir Harry Verney the odd fact that Shaw Stewart’s mother wore mourning black on the anniversary of the execution of Charles I (letter 4 June 1892, Wellcome 9014/25).

In 1866, while lady superintendent at Netley, Shaw Stewart was accused of abusing a nurse. Nightingale thought that she should be reprimanded, not dismissed, but given a second chance. She stayed on. However, in 1868, there were new charges, and a committee of enquiry was established by the War Office (Dr Sutherland was a member). It held hearings for a week. Wilbraham’s evidence was damning.

A nurse complained that she had been abominably treated: Shaw Stewart clapped her hands, stamped her feet and slammed the door. She gave an egg to a patient without medical direction. Dr Longmore, a Crimean War surgeon and later professor of military hygiene there, stated that the nursing under Shaw Stewart was a failure. Evidence against her was brought also by a corporal and a sergeant major. Shaw Stewart made no reply to any of the charges and asked no questions of any of the witnesses. She left, although whether by dismissal or resignation is not clear.

Shaw Stewart later consulted Nightingale about publishing her “trial and defence.”

Senior nurses kept in touch with Shaw Stewart, who passed on information from them to Nightingale. Hence that their correspondence goes on to 1888, when Shaw Steward was living in retirement  initially in in Horsham, Sussex. She took no further position, advised on who would best replace her as interim superintendent, could not recommend anyone for the permanent post. She continued to identify as a nurse, registering herself as a nurse in the Censuses of 1891 and as a retired hospital nurse in 1901.

Shaw Stewart’s “Thoughts Submitted” on Army Nursing”

Jane Shaw drafted material, on army nursing, presumably at Nightingale’s request, and which she edited. Nightingale wrote most of the material, but it appears that the opening segment was Shaw Stewart’s, titled “Thoughts Submitted by Order concerning Hospital Nurses,” related below. It is the opening section of  Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and in War, noted as “Private and Confidential,” 1858 . Shaw Stewart’s section is omitted in the publication of the Collected Works of Florence Nightingale (in 15:19-145).

Shaw Stewart’s analysis shows careful thought about a comprehensive system of army nursing, with positions defined, uniforms, performance reports, wages (high), working hours, pensions and rations served at meals. Nothing close to these recommendations was ever implemented in the next decades.

Shaw Stewart showed some reticence about the use of nuns, whether Anglican or Roman Catholic, in army hospitals. She was well aware of the problems that many of them (not all) posed during the Crimean War. She made a vague statement about the importance of religion, especially the “National Church,” or the Church of England.

Today’s readers may be upset by such requirements as 12-hour shifts for night nurses, with instant dismissal for anyone caught sleeping. However, provision is made for adequate sleep and outside exercise. Nurses are never supposed to fetch nothing. Shaw Stewart was not firm, but suggested that only “head nurses” be employed in army hospitals, in her terms “persons of the character, responsibility, and efficiency,” as in other hospitals. She was making this point two years before the opening of the first nurse training school. “Head nurse” would soon mean a trained nurse.

As for handwritten texts, this text has been edited particularly on the copious  use of hyphens , as in “hospital-nurses,” “night-nurses,” and capitals for common nouns like “General Hospital.,” although capitals are left in in titles and side bars. Words originally in side bars are indicated by quotation marks.

 

PRIVATE AND CONFIDENTIAL

THOUGHTS SUBMITTED BY ORDER CONCERNING

1. HOSPITAL NURSES
2. NURSES IN CIVIL HOSPITALS
3. NURSES IN HER MAJESTY’S HOSPITALS
4. HOSPITAL NURSES

 

“Definite Objects: road to them to be found out”

1. It would appear desirable to consider that definite objects are to be attained; and that the road leading to them is a large extent to be found out–therefore to consider all plans and rules, for some time to come, as in a great measure tentative and experimental.

 

“Presumed Main Object”

2. The main object I conceive to be, to improve hospitals, by improving hospital nursing; and to do this by improving, or contributing towards the improvement, of the class of hospital nurses, whether nurses or head nurses.

 

“Presumed Intention”

3. This I propose doing, not by founding a religious order; but by training, systematizing, and morally improving as far as may be permitted, that section of the large class of women supporting themselves by labour, who take to hospital nursing for a livelihood, by inducing, in the long run, some such women to contemplate usefulness, and the service of God in the relief of man, as well as maintenance, and by incorporating with both these classes a certain proportion of gentlewomen who may think fit to adopt this occupation without pay, but under the same rules, and on the same strict footing of duty performed under definite superiors. These two latter elements, if efficient (if not, they would be mischievous rather than useless), I consider would elevate and leaven the mass.

 

“Religious Orders”

4. It may or may not be desirable to incorporate into the work, either temporarily or permanently, members of religious orders, whether English or Roman Catholic, or both, who may, with the consent of their superiors, enter hospitals nursed under the above system, upon the definite understanding of entire obedience to secular authorities in secular matters, and of abstinence from proselytism.

 

“Their Advantages”

5. Great and undoubted advantages as to character, decorum, order, absence of scandal, protection against calumny, together with, generally speaking, security for some amount of religious fear, love and self-sacrifice, are found in the system of female religious orders.

 

“Advantages of Hired Labour”

6. On the other hand, the majority of women in all European countries are, by God’s providence, compelled to work for their bread, and are without vocation for orders.

In England the channels of female labour are few, narrow and overcrowded. In London and in all large towns, there are accordingly a large number of women who avowedly live by their shame; a larger number who occupy a hideous borderland, working by day and sinning by night; and a large number, whether larger or smaller than the latter class is a doubtful problem, who preserve their chastity, and struggle through their lives as they can, on precarious work and insufficient wages. Vicious propensities are in many cases the cause, remediless by the efforts of others, of the two first classes; want of work, insufficient wages, the absence of protection and restraint, are the cause in many more.

Perhaps the work most needed now is rather to aim at alleviating the misery, and lessening the opportunities and the temptations to gross sin, of the many; than at promoting the spiritual elevation of the few, always supposing that this latter object is best effected in an order.

At any rate, to promote the honest employment, the decent maintenance and provision, to protect and to restrain, to elevate in purifying, so far as may be permitted, a number, more or less, of poor and virtuous women, is a definite and large object of useful aim, whether success be granted to it or not.

The Orders remain for the reception of those women who either are or believe themselves drawn to enter them, or who experience their need of them.

 

“Main Object of Hospitals; Distinct Functions of Hospital Clergy and Hospital Nurses”

7. The care of the sick is the main object of hospitals. The care of their souls is the great province of the clergy of hospitals. The care of their bodies is the duty of the nurses. Possibly this duty might be better fulfilled by religious nurses than by sisters of any order; because the careful, skilful, and frequent performance of certain coarse, servile, personal offices is of momentous consequence in many forms of severe illness and severe injury, and prudery, a thing which appears incidental, though not necessarily so, to female orders, is adverse to or incompatible with this.

 

“Objections to Amalgamating Members of Orders with Secular Nurses”

8. Grave and peculiar difficulties attend the incorporation of members of orders, especially Roman Catholic orders, into the work. And, both with reference to the Queen’s hospitals, and still more to the civil hospitals, I humbly submit that much thought, and some consultation with a few impartial and judicious men, should precede the experiment of their introduction. This appears to me one of the most important questions for decision. Should it be decided in favour of their introduction, I trust it may be resolved to do so only tentatively and experimentally.

I confess that, subject to correction and modification from further experience or information, my belief, the result of much anxious thought and actual experience, is, that their introduction is certain to effect far more harm in some ways than it can effect good in others; that a great part of the advantages of the system of orders is lost when members are partially incorporated in a secular, and therefore, as they consider, an inferior system; and that their incorporation, especially as regards the Roman Catholic sisters, will be a constant source of confusion, of weakness, of disunion and of mischief.

Saint Vincent de Paule[1] well knew mankind, when he imposed, amongst other things, the rule on the sisters of his order never to join in any work of charity with the sisters of any other order. This rule was mentioned to me on an occasion which gave it weight, by the superior of the Sisters of Charity of one of the two Sardinian hospitals on the Heights of Balaklava, in the spring of 1856, and by the Mere Generale at Paris, October 1854, when she was solicited by me, with the assent and sanction both of the English and of the French governments, to grant some of her sisters at Scutari.

“Ladies”

9. As regards ladies, not members of Orders, peculiar difficulties attend their admission: yet their eventual admixture to a certain extent in the work is an important feature of it. Obedience, discipline, self-control, work understood as work, hospital service as implying masters, civil and medical, and a mistress, what service means, and abnegation of self, are things not always easy to be learnt, understood, and faithfully acted upon, by ladies. Yet they cannot fail in efficiency of service or propriety of conduct–propriety is a large word–without damaging the work, and degrading their element. Their dismissal (like that of sisters) must always be more troublesome, if not more difficult than that of the other nurses.

It might be better not to invite this element; to let it come if it will learn, understand, and do what has to be learnt, understood, and done: if not, it is better away.

It appears to me, but I may be quite mistaken, that, in the beginning, many such persons will offer themselves, but few persevere; that in time a sufficient number will form an important element of the work; more is not desirable.

It seems to me important that ladies, as such, should have no separate status; but should be merged among the head nurses, by whatever name these are called. Thus efficiency would be promoted, sundry things would be checked, and the leaven would circulate.

There are many women, daughters and widows of the middle classes, who would become valuable acquisitions to the work, but whose circumstances would compel them to find their maintenance in it. These persons would be far more useful, less troublesome, would blend better and more truly with women of the higher orders, who were in the work, and would influence better and more easily the other nurses, as head nurses, than as ladies. Whether or not the better judgment of others agrees with mine, by meaning will be understood.

In truth the only lady in a hospital should be the chief of the women, whether called Matron or Superintendent. The efficiency of her office requires that she should rank as a lady and an officer of the hospital. At the same time, I think it important that every matron and superintendent, (unless during war service, when the rough and ready life and work required will probably be best undergone by women of a higher class) should be a person of the middle classes, and if she requires and receives a salary, so much the better. She will thus disarm one source of opposition and jealousy, and enough will remain, inseparable from her office.

The quasi-spiritual dignity of Sisters of Mercy is a thing sui generis. But the real and faithful discharge of the duties of the wards of a general hospital, whether with reference to superiors, companions, or patients, is incompatible with the status, as such, of ladies. The real dignity of a gentlewoman is a very high and unassailable thing, which silently encompasses her from her birth to her grave. Therefore, I can conceive no woman who knows, either from information or from experience, what hospital duties are, not feeling as strongly as I do, that either the assertion or the reception of the status as such of a lady, is against every rule and feeling of common sense, of the propriety of things, and of her own dignity.

“Religion”

10. The question of the mode of Religion is an all-important, and the choice of a mode bears far more directly upon this work than may, at first sight, appear. To give up the common ground of membership of the National Church is to give up a great source of strength.

“St John’s House”

St John’s House, if it steers clear of the rock of prudery, undoubtedly possess great advantages over a system of hospital nursing by promiscuous instruments. Not because it includes a Sisterhood, a system, in which I, for one, humbly but entirely disbelieve; but because the laborious, servile, anxious, trying drudgery of real hospital work (and to be anything but a nuisance it must ever remain a very humble and very laborious drudgery), requires, like every duty, if it is to be done aright, the fear and love of God. And in practice, apart from theory, no real union can ever be formed between sects. The work now proposed, however, must essentially forbear to avail itself of the bond of union of the National Church.

“Only Women of Unblemished Character should be employed”

11. None but women of unblemished character should be suffered to enter the work, and any departure from chastity should be visited with instant final dismission. All applications on behalf of late inmates of penitentiaries, reformatories, of all kinds and descriptions, should be refused. The first offence of dishonesty, and, at the very furthest, the third offence of drunkenness, should ensure irreversible dismissal. No nurse dismissed, from whatever cause, should be suffered to return.

“Provision for Old Age”

12. It is very important, if possible, to make provision for the disabled age of deserving nurses. It does not seem to me, I speak very diffidently, desirable to concentrate them in one or more large buildings. I believe half the inmates of half the alm-houses, etc., are not on speaking terms with each other. John Bull is of a peculiar idiosyncrasy: nowhere are there such homes as in England, but life in community does not seem congenial here. A pension and the option of ending their days in solitary quiet, or with some friend or relation, would probably be the most comfortable arrangement for nurses.

“Progressive Increase of Wages”

13. Many women are valuable as nurses, who are yet unfit for promotion to head nurses. It appears to me that it would be very desirable to have an intermediate recompense: say, after ten years’ good service, to raise nurses’ wages; after a second ten years, to raise them further.

“Fixed Age for Admission and Retirement”

14. There should be an age for the reception and for the retirement both of nurses and head nurses. I think no head nurse should be under thirty.

“Simplicity of Rules, Definition of Authorities”

15. Simplicity of rules, placing the nurses, in some respects, absolutely under the Medical man, and, in others, absolutely under the Female Superintendent, is very important; also, at the outset, to have a clear and recorded definition of these respective limits.

“Economy”

16. Economy is very important, with regard to the eventual extension of the work.

“Commencement: Training”

17. In the event of the nurses not being trained in Her Majesty’s service, advantage, it seems to me, would attend their beginning in a great established hospital; unless indeed it should be judged best to select and train a staff or nurses first in a smaller and quieter one. Yet much that would be unpleasant in the larger place would probably be beneficial. The restraint, control, contact with the masters, work, and order of things of a great and settled place, would materially help with reference to the nurses.

“Limits”

18. Common sense will assuredly make the fixed resolve; both to fulfil one’s duty, and to keep within it. It is essential to do the latter as the former, and often more difficult, especially for women; most especially for hospital nurses.

“Encumbrance of Public Support or Patronage”

“Caution, Non-expectation, and Trust”

19. It appears to me most important to be free, once and for ever, from the injurious, untrue, and derogatory appendage of public patronage: what is called support in these days always end in patronage: what is called support in these days always ends in patronage. This work, truly understood, never has been, never will be, never can be, a popular work; for many reasons, one of which is that they public, of all orders, never can know anything of the real nature of hospital work. With the best intentions, it will therefore make perpetual and impeding mistakes in “supporting” or patronizing it. Its support and patronage are equally injurious in different ways as regards our masters the medical men, ourselves the nurses, and people who are neither medical men nor nurses.
20. I end as I began. Let nothing be done rashly. Let us not be fettered with many rules at first. Let us take time to see how things work; what is found to answer best; how the work proceeds; how far it pleases God to accept and bless it. Let us be prepared, as I know well we must be, for disappointments of every sort and kind. What can any of us do in anything, what are any of us meant to do in anything, but our duty, leaving the event to God? His Will be done in earth, as it is in Heaven.

II.NURSES IN CIVIL HOSPITALS

“Isolation of each Head Nurse and her Nurses”

1. The isolation of each head nurse and her nurses appears to me very important. The head nurse should be within reach and view of her ward both day and night. Associating the nurses in large dormitories tends to corrupt the good, and make the bad worse. Small airy rooms contiguous to the ward are best. The ward should have but one entrance, and the head nurse’s room should be close to it, so that neither the nurse nor patient can leave, nor anyone can enter the ward, without her knowledge.

“All to Rank and be Paid alike, with Progressive to Increase of Wages”

2. All the nurses should rank and be paid alike, with progressive increase of wages after each ten years’ good service, or a slow annual rise, which is better.

“Night Nurses”

3. The night nurses should be on duty 12 hours, with instant dismissal if found asleep; 8 hours should be allowed for sleep, and 4 hours for daily exercise, private occupation, or recreation. If they have no time to themselves for their mending, making, etc., they do it at night, sometimes innocently, sometimes to the injury of the patients. I would not however prohibit occupation at night; as sometimes the ward duty is slight; and doing something is far better and more awakening than doing nothing. This is one of the matters the head nurse should constantly look to. I do not fancy, but at present am not positive about, cleaning or scrubbing at night. The night nurse should have a reversible lamp, or something that without disturbing the patient, gives her light, brighter than the dim fire or gaslight properly maintained in the wards at night. She should have a room to herself.

“Day Nurses”

4. The day nurses should have eight hours’ sleep, and if it be possible, 4 hours daily for exercise, private occupation or recreation. They may have one room.

“Nurses to fetch nothing”

5. All provisions, etc., etc., should be as much as possible brought into the wards, or to the ward doors, by lifts. Nothing should be fetched the nurses. This would save much time; would enable the nurses to do more work, and yet have more leisure; and above all, would obviate the great demoralization consequent in numbers several times daily.

“Patients to fetch nothing”

6. The patients should be made as useful as possible, consistently with their capacities, inside the ward; but should be permitted to fetch nothing to it.

“Scrubbing”

7. I strongly incline to have the scrubbing done in each ward, by a nurse assigned for that purpose, and for general attendance when scrubbing is done. There should be purpose, and for general hours for the scrubbing, before and after which it should not be done. This whole matter is one on which I am not positive at present.

“Distribution of Ward Work”

8. At present, I incline to something of the following scale. Two wards, single are best, but it might be one double ward, with 40 beds, served by 1 head nurse and 3 nurses. The head nurse to superintend all things, and to do the dressings not done by the surgeons and dressers, assisted mainly by one nurse, whom she thus instructs in nursing. Another nurse to do the scrubbing, and mainly the cleaning, and when these are over to mind the ward during the remaining hours in turn or in conjunction with the first nurse. The third to be night nurse. In the morning, before dressing begins, and before the night nurse goes off duty, all three nurses to be clean the ward, make the beds, wash the helpless, etc.

“Hours of Dressing and Poulticing, and of Medicine”

9. Hours of morning and evening poulticing and dressing to be fixed.
10. Hours of administration of medicine, always except at night given by head nurses, to be fixed.

“Hours of Exercise and Holidays”

11. Hours of exercise of head nurse and nurses to be fixed, and arranged with reference to the ward-duties. A fixed occasional holiday given in turn to the nurses is good. An annual longer holiday for them and for the head-nurses is good; a fortnight is, I think a good limit. The holidays cause inconvenience, no doubt, but on the whole do, I think, far more good than harm. The holidays should be distributed in rotation during a fixed time of year, and comprehended in two or three months, or four at the very outside; and no woman declining her holiday at the proper time should be allowed it at any other.

“Permission of Matron for extra time out”

12. No head nurse or nurse should be out of the hospital before or after the limit of her daily exercise time, two hours, without written permission of the Matron. The matron, I think, should put the cause and amount of the extension in writing, and report the same to the Treasurer or Chief Officer, at the next general meeting, whenever it is called, of the Officers of the Hospital. She will find this a great protection against petitions. There is not a doubt that the fewer extraordinary absences, the better.

“Place of Exercise”

13. Were it possible to have a small garden (in college gardens much effect and much refreshment is produced by a green sward, a few trees, some shrubs, a fountain, and some seats), in this, at strictly separated hours, the men patients, the women patients, the head nurses and nurses, the men-servants, if they choose, which perhaps is not likely, could walk or sit down. This arrangement would little interfere with its enjoyment by the dignitaries and their children, who require it quite as much, and would be found in its results practically and not poetically useful. Hospitals are, and perhaps must be, in or near crowded thoroughfares. Streets are miserable places to walk in during great part of the year. Nurses want and unconsciously crave for fresh air, and often half an hour is better than more, given them close to their work—and away from the streets, it would be often a great preservative.

“Caution”

14. I should, however, be very cautious as to introducing music or anything of that sort. Hospitals are not tea gardens, nor homes, nor meant to be either. Great quiet and some severity of discipline are necessary, and ought to be exacted.

“Dress”

15. I think the head nurses should wear a regulation dress, and the nurses another; if we adopt the honest work livery in use in the hospitals, it will perhaps do no harm. Caps, dresses, aprons, should be prescribed: whether or not out-of-door dress should be prescribed is to be considered apart. Each should have three dresses yearly. Better, I think, avoid washing stuffs; they require endless change to look decent. Head nurses and nurses might wear the same dress, and some difference in the cap would be quite distinction enough.

“Wages”

16. I incline towards giving the head nurses 50 pounds a year, one or two rooms (one room with an alcove and curtain would be best) fuel and light. The nurses lodging; the night-nurse a room to herself, the others together, entire board, fuel, light, and good wages to be decided upon.

“Furniture”

17. The nurses’ rooms should be supplied with plain comfortable furniture. In the large Hospitals the head nurse furnishes her own room or rooms, which doubtless promotes her comfort and her care of the furniture, both desirable things; yet the tendency of many to accumulate decorations, which take time to clean, etc., is a drawback. I should be inclined, as an experiment, to try the furnishing plan, or at least to have some scale as to furniture allowed. A bed, armchair, and sofa; a chest of drawers, was hand table or shelf; bookcase or shelves; a little table and a larger one, a couple of chairs, a footstool, and a cupboard with broad shelves, are the utmost that can be required.

“Visitors”

18. A difficult and important point to settle is the amount of liberty allowed as to receiving visits. It is desirable on all accounts to make head nurses and nurses feel comfortable, and, as it were, at home: it is also better they should not be necessarily out; also London distances are great, and even, omnibus-fare is a consideration; also it is important to remember that these women are apt to feel and say” “We are not in a nunnery,” nor should they be. Still upon the whole, considering the nuisance of ordinary visitors, and the greater nuisance of extraordinary (e.g., visitors to some head nurses, kind friends come to see how we are getting on, etc, etc, etc), I think if it were possible or not—still less whether it is possible to keep such a rule, if made. But, at all events, nurses and head-nurses should only be permitted to receive visitors on certain days and hours of the week; and those hours and days should be strictly kept to. In Military Hospitals a still more rigid rule will be necessary.

“Discharged Patient”

19. No discharged patients, however previously well conducted, should be allowed to visit the wards.

“Graduated scale of Pensions”

20. Apart from raising the wages of good nurses after every ten years’ service, I think it would well answer to establish a graduated scale of pensions, for both head nurses and nurses; beginning with a small pension after ten years’ good service, increasing every five years afterwards. Many women are quickly worn out in this life; and it is equally undesirable to turn faithful worn-out servants adrift without any provision, or to retain them in duties for which they are become unfit. It is a question whether there should be to entitle the nurses to pension under conditions.

“No occasional Wards”

21. Have no occasional wards, or wards for accidental and peculiar patients.

“Head Nurse to each Ward”

22. Every ward, or set of wards, should be under a head nurse. Discipline is always under other arrangements.

“Religious Influence”

23. This turns greatly upon a previous question. Every endeavour should be used to bring the women under the influence of religion, God’s instrument for saving, strengthening, and comforting souls. So far as this work depends on the rule, system, and superintendence, great things may be done at any rate—so far as moral influence is concerned, it can only be hoped for in the channels appointed by Him who turneth all hearts whithersoever He will.

 

III. NURSES IN HER MAJESTY’S HOSPITALS.

“Two kinds of Hospital Service for Females”

1. If their introduction is eventually commanded by that Queen’s Government, it will be advisable to consider that their service admits two distinct kinds.

“The one: its Advantages”

2. “Their chief duties” may be “taking charge of the linen and superintending the issue of extras”

They will thus contribute materially to the comfort and well-being of the sick; the real difficulties which undoubtedly beset the introduction of women into ward service will be avoided; and an important consideration, not lightly to be discarded, their exclusion from the ward service will materially diminish the opposition of adverse masters, some of whom are also unscrupulous masters.

“The other: its Advantages”

3. On the other hand, I suppose, the experience of every woman, admitted to ward service in hospitals where women were not before, is that many lives are actually saved by such admission, which would otherwise, humanly speaking, be lost. In time of war some ciphers may be safely added to the many. Any other great emergency, I suppose, but do not speak from experience, would give the same result.

That the experience of many surgeons is identical, their conduct has proved; no other testimony, under present circumstances, can rationally be expected from them.

“Both to be Weighed”

4. It is often right to begin with the smaller and less-opposed good, and to introduce gradually, and, as it pleases God, the remainder. It may be our duty to do this, as to this matter.

“Practical Superiority of the Second”

5. Practically, it is of little avail to superintend, ever so carefully, the issue of extras to the sick, unless there is permission and opportunity to pour the nourishment, perhaps in continual drops, down the throat of reluctant agony, or delirium, or stupor. And it is of little avail to have this permission, unless there be also that of raising the decent covering under which cholera, erysipelas, or the oppression of long, recumbency, or the discharging wound, or the recent operation lie, and seeing to matters within. It is a further question, whether the painful cleansing of painful wounds, and the important minor dressings, as poulticing, which things, generally speaking, never have been done, and never will be done by surgeons, are best left to nurses, orderlies, or the patients themselves.

“Its real and great Difficulties”

6. At the same time, nothing is more pernicious than to under-rate the objections of opponents. There is no doubt that the admission of women to ward service is beset with difficulties. These naval and military hospitals are, and must ever be, peculiar hospitals, essentially different in important details from the civil hospitals.

Sisters of Mercy, as regards the ward service, are decorous and kind, and sometimes inefficient and prudish. Nurses are careful, efficient, often decorous, and always kind, sometimes drunken, sometimes unchaste.

Misconduct of women is far more pernicious in a Military or Naval Hospital than in any other, as regards the result of things—the crime is, of course, equally crime everywhere.

“Condense numbers as much as possible”

7. It appears to me desirable to simplify and condense, as much as possible, female service in these Hospitals. Let there be as few women, and these few as efficient and as respectable as can be. Let all that can really be done by men be so done.

“Only Head Nurses”

8. Head nurses are alone, I think, desirable to be employed; I mean persons of the character, responsibility, and efficiency, of head nurses is other hospitals.

“Classify the Patients”

9. The patients should be distinctly classed, though, of course, this is not the Female Superintendent’s business.

There are many pros and cons to the formation of convalescent wards.

It is a question whether the convalescent or chronic patients require female nurses at all.

Of such chronic cases, probably 100 would be efficiently served by one nurse, having orderlies under her. Of acute cases, probably, one nurse should take charge of not more than fifty, possibly not more than forty.

“Qualifications of Nurses”

10. The nurses should be strong, active women, of not less than thirty, nor, I think, more than sixty years of age, of unblemished character, and should be irreversibly dismissed for the first offence of unchastity, drunkenness, or dishonesty, or proved impropriety of any kind.

“Wages”

11. Their wages, I think, the same as those of head nurses in Civil Hospitals—certainly, not more.

“Pensions”

12. Their pension on the same graduated scale.

“Rules”

13. Their rules should be simple, very definite, should leave them at the absolute disposal of the Female Superintendent in all other matters. Their dress should be uniform.

“Duties”

14. Their duties should be strictly defined, and be consistent with the Code of Army Hospital Regulation, the revision of which has been announced.

“Means of Steadying them Lodging”

15. Give them plenty to do, and great responsibility—two effectual means of steadying women.
16. The nurses’ lodging in view of her ward renders her far more efficient; but this requires some special arrangement. It would not do to have the chance of the nurse’s being suddenly taken ill, with only patients and orderlies within immediate reach. Were the nurses’ rooms so arranged that two or more were on one floor (as is the case in all Hospitals), and so arranged as to be entirely separate, and yet, when do desired, easily accessible to each other, which might easily be contrived, this would probably answer all purposes.

“Food”

17. Their food should be sent them cooked with some slight variety. With the plainest intentions nature often revolts from the perpetual joint of excellent meat in hospital air and life. The occasional “potage,” fish, etc, of other systems, are in fact, a refreshing and palatable change. If, however, avoiding names that shock and frighten, some slight change of diet could be contrived, the effect would be good. This is practical and not at all romantic, though it may look the latter.

“Opinion of honest Military Authority desirable. Female Superintendent General”

18. Could the honest opinions be had of a few good Military and Surgical Authorities before beginning, it would be good.
19. The Female Superintendent-General’s own powers and responsibilities must be absolutely fixed, and so as not to clash with those of the Officer (should such an Officer be appointed, as has been elsewhere recommended), who shall superintend the Hospital attendants.

“Confidential Reports”

20. Confidential reports must be so modified, as far as women are concerned, that the humble boon granted to pickpockets, of being informed of accusations laid to their charge, must be extended to Her Majesty’s nurses.

“Permanency of the System”

21. In framing the system and the Superintendent’s own office, let it be attempted to secure the permanent efficient working, please God, in ordinary hands. To aim at the best conceivable may lead to failure. Genius works with ordinary materials, but never constructs an edifice which it alone can inhabit.

“Quietness”

22. “In quietness and in confidence shall be your strength”

Quietness has been from the beginning of its publicity the one thing wanting in this work. I know the fuss, which from its beginning surrounded it, was abhorrent to us and was the act of others: but the work, which is all we care for, has throughout suffered from it. It is equally injurious and impeding as regards surgeons, nurses, and people, who are neither. External help in this coarse, repulsive, servile, noble work, for it is all these things, is truly the reed which pierced the hand that leant upon it. One hospital, naval, military, or civil, nursed well, and gradually training a few nurses, would do more good to the cause than an endless amount of meetings, testimonials, pounds, and speeches, to say nothing of newspaper puffings, which tomorrow might turn into revilings. This never will, never can be a popular work, Few good ones are, for few are without the stern fructifying elements of moral restraint and influence; and though the streams of this are many, its source is one. Hearts are not touched without religion. Religion was not given us from above in impressions and generalities, but in the habits of thought and action, in love of God and of mankind, carried into action.

Shaw Stewart Obituary

The Times obituary of her after her death was respectful, revealing nothing of the stormy career she had had in army nursing:

Another link connecting the present generation with that of the Crimean campaign has been severed by the death last week of Miss Jane Catherine Shaw Stewart, sister of the late Sir Michael Shaw Stewart, of Ardgowan, Greenock. She was associated with Miss Florence Nightingale in active nursing work in the military hospitals in the Crimea and at the close of the war appreciation of her practical services was shown by appointing her matron superintendent at Netley Hospital, in which capacity she served until 1868. For many years past she had lived in retirement in the country village of Slinfold, Sussex, where, by her own request, she was buried, her funeral attended by her nephew, Sir Hugh Shaw Stewart, M.P., and a few intimate friends (Obituary, Times 21 March 1905, 5).

References

Nightingale, Florence. Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and in War. Presented by request to the Secretary of State for War. London: Harrison & Sons 1858.

Summers, Anne. Angels and Citizens: British Women as Military Nurses, 1854-1914. London: Routledge & Kegan Paul 1988.

Times. Obituary Times 21 March 1905 5.

 

Jane C. Deeble: Introduction

After the stormy leadership of Jane Shaw Stewart, Deeble will seem very tame. She it was, however, who really established professional army nursing, both for the British Army at home and at war. Jane Cecilia Egan Deeble (1827-1913) was age 40 when she entered the Nightingale School in 1869, the widow, with four children to support, of a surgeon-major who died in the Abyssinian campaign of 1867.

Thus, without experience post-training experience, Deeble in 1869 was appointed the second superintendent of the largest army hospital, the Royal Victoria Hospital, Netley. Then, in 1870, she was the first to be given the title “lady superintendent of the Army Nursing Service.”  1879, she took the first team of Netley nurses into war, the Zulu War. As a result of that service, in1883 she was given the Royal Red Cross, an award instituted by Queen Victoria particularly to honour women who had nursed in South Africa. Thus she appears on the first list of RRCs, after Nightingale, and the  nine royal and noble ladies before her.

Nightingale thought that she should have had more actual nursing experience before these appointments, as she pointed out in a letter to Henry Bonham Carter (letter 3 August 1869,  LMAH1/ST/NC18/15/13 15:197), but no one else more experienced was available. In any event, Deeble performed well in her various tasks, both in heading the nursing at Britain’s largest peacetime army hospital, and taking nurses to war, after the Zulu War and the first Egyptian Campaign. She headed the nursing at Netley from 1869 to her retirement in 1890, a record length of stay. She brought order and professionalism after the unpleasantness and confusion left by Shaw Stewart..

Extracts from Deeble’s letters to Nightingale below show that she was competent and diligent, caring about her patients and regardful of the workload and working conditions of her nurses. She clearly appreciated Nightingale’s advice, but was not unduly demanding. She had had little regular nursing experience before taking on the lead role, and had to deal as well, with sisters who lacked basic skills. She succeeded in running the nursing well there and sending out nurses from Netley for British campaigns abroad.

There are numerous surviving letters from Deeble, 115 folios from 1869-92 (Add Mss 45775), but only notes by Nightingale of their meetings, and a few letters. Deeble’s letters to senior officials as well show competence, such as one to the secretary of state for war, on “the extreme impracticability of the contemplated alteration for quarters of the nursing staff.” She explained that privacy in living quarters was an issue, and gave details of her plan, which would prevent intrusions at all hours” (Deeble letter 31 December1871, Add Mss 45775 f75). Defects in housing arrangements were issues for nearly all superintendents. She had, in common with other nursing leaders the challenge of getting doctors and administrators to provide more resources.

The material given below consists of extracts and paraphrases rather than full letters, but should be adequate to convey the work Deeble had to perform and the defects she had to deal with.

 

Nursing at Netley Hospital

Excerpts from letters from Jane C. Deeble, Add Mss 45775 ff1-2, 3-8, 9-15

Royal Victoria Hospital

Netley

30 November 1869

Deeble described having been a week at Netley and found “all earnest in desire” to help her, but sisters had not risen to their responsibilities.

Sister Lennox[2] has already been ill, missing attendance at an important amputation case and has expressed a desire to resign, as she feels unequal to the work physically. Emm had mistakenly given a rheumatic patient a dose of liniment in lieu of cod liver oil, which the patient vomited with no serious results.

[      Deeble continues with the mistake and report on it to the medical doctors. Sisters are getting, finding the military route quite different to civil hospital work, She wishes to keep in close communication with Nightingale as if she were among them.

2 December 1869

Deeble noted the time lapse before acknowledging Nightingale’s letter, with a strengthened resolution to lay bare mistakes that might occur. The sisters were well and doing their best; the surgeons were pleased with Clark and Lennox in the way they attend to wounds. The doctors of the Medical Division were satisfied with their Sisters. Kennedy, Strong and Emm, with Emm doing her best to improve, Sister Lennox was happier and her wards were getting into order….was rather “faint hearted” to take over probationer orderlies but ‘is making her way slowly and surely.

Their home (residence) was getting more “home-like.” Deeble described the status of the Linenry, her request to cover the principle passages with bi1l cloth, frequent scrubbing keep the quarters damp and cold where there are no fires. She reported on the status of the leg amputation patient, good , and of another possible amputation; the patient happy to be among the sick soldiers.

She reported on her desire to reform the present system of bandages and how it would work,

General Wilbraham writes to say she is to receive furniture for her sitting room from the government, to be selected in Southampton.

13 January 1870

Deeble explained the delay in answering Nightingale’s kind letter; she is fully employed; there is much to be done in medical wards with arrival of invalids on Xmas and several bad cases. She is pleased to report the sisters meet with the approbation of the senior medical men and are valued by patients,

She found the discipline of the night orderlies to be bad, and she did what she could to present the situation to the senior medical officers and to the General. There is improvement and Deeble does not find them ‘quite between the blankets with their pipes.” She finds great comfort and satisfaction in her night work, Sister Lennox is more content, Emm tries her best but is lacking in intelligence and tact, She informed Dr Maclean she did not know how to apply ether spray to a quinsy patient.

The orderlies bandage well, keep wounds clean and make poultices and dressings, yet, as the old story goes, the most experienced is not always to be trusted. She can ease Nightingale’s mind on the instant removal of all dressings and soiled bandages from the wards.

Mr Bonham Carter sent her questions to answer on the sisters ‘pay as she was unable to answer the Paymaster. Furniture for their sitting room had arrived…

Arrangements need to be made for answering the constant ring of the inner bell, 80 yards from the kitchen, bells ringing everywhere and need to be re-arranged. She had also requested a half partition for the servants’ room, but did not think it would be granted; £200 had already been spent in making alterations in building for the nursing staff. They are allowed 13 boxes of coal weekly, a messy job to bring to kitchen through dormitory passage and her sitting office. She wishes to have all coal boxes removed from kitchen, to keep fatigue party out of their home bringing in coal. They have a “Blue Coat boy”[3] and Nelly [her daughter] for the holidays who add to her comfort, Nelly visits wards on Xmas day.

Deeble said that she would be glad to get new Regulations. She, has kept her acquaintance with Mrs Wardroper and wishes her sisters to continue the same….Mochler [4]not, however, in same spirit she intended, wishes these thoughts to be known only by Nightingale, is willing to improve or dispose of practices at Nightingale’s request.

A Deeble letter of 18 February 1870 shows appreciation for Nightingale’s writing her, to go on to moving coal boxes to an outer passage, which gave them more privacy in their “home.”  She had been at Netley three months now, and wanted to see Nightingale when she goes to London on the 23^rd.Work on the wards had been heavy, with Sister Clarke having four operations the following day eye cases, excision of elbow joint and other private case doing well.

Deeble would visit Mrs Wardroper as well as Nightingale on the 23rd.

She reported that the weather had been “trying,” especially for the new arrivals from India. She closed with “respectful remembrances from the sisters” to Nightingale.

General Wilbraham, the commandant at Netley at Netley, wrote Nightingale promptly with a positive account of Deeble’s start:

I think that you will be pleased to hear from me, what Mrs Deeble would not want to tell you, viz., the great satisfaction that the resumption of the nursing service has given not only to myself but to all the medical staff of this hospital. In the few days that they have been in the wards, the nurses had made a most formidable impression upon the medical officers in charge of both the medical and surgical divisions, not only by their thorough knowledge of their work, but by their kindness touching everyone with whom they are brought into contact.

They have, I think, taken very kindly to their new mode of life and Mrs Deeble seems to be judicious and, at the same time, so considerate in her management of them that I confidently trust that all will continue to work harmoniously. I hope also that Mrs Deeble will find her position here comfortable, nor do I doubt it, for she evidently has thrown her heart into her work, and she is sure to receive from those medical officers with whom she will be brought with official intercourse, not only support but kindness (Wilbrahm letter 28 November 1869, Add Mss 45802 ff181-82).

In a letter in February 1870, Deeble gave further details of her projected visit, declined the kind offer of dinner. They had 60 new arrivals from India, “all looking pretty miserable,” and operations of the previous day had gone well, followed by a comfortable night. Dr MacKinnon[5] was pleased with the surgical sisters. They were making new eye bandages for three cases operated on, with a pattern from the London Ophthalmic Hospital Deeble (letter 8 February 1870m Add Mss 45775 f18). A letter in March included numerous practical details, and revealed such problems as a nurse not knowing how to take a patient’s temperature, and one who applied leeches so close to a patient’s eye as to cause hemorrhage (Deeble letter 8 March 1870, Add Mss 45775 f f26). Another  Deeble letter described the heavy cases they had and increases expected. She wondered who would succeed their medical director, General Wilbraham, who had been “very supportive of their new start.” Her greatest difficulty was “beating the orderlies into shape.” Sisters were trying to teach them some nursing practicalities. The manual of instruction for orderlies was good, so that she intended to read parts of it to the sisters. She reported on the progress made by some staff (Deeble letter 20 March 1870, Add Mss 45775 f30).

Another Deeble letter reported a letter from the War Office cutting her pension, from her husband’s position, by £90 because of her Netley appointment. She “would not submit to being deprived of even  £1 of what was awarded to her by Her Majesty for which her husband worked 22 years.” This might affect her current appointment—she would consult friends (Deeble letter  6 May 1870, Add Mss 45775 f44). Nightingale presumably sent back a sympathetic reply, for Deeble’s next letter gives descriptions of her coming expenses for the education of her sons. The eldest two were to go into the Army Medical Service. She would do her best “amidst the difficulties  and prays to God for daily direction.” The rest she “left to a higher Power who will make all things work together for good “ (Deeble letter  31 May 1870, Add Mss 45775 f48). A letter soon after, looking forward to their meeting,  reported a “windfall” of money for her children’s education, including something from the Royal Patriotic Fund and a nomination for the eldest son to go to Wellington College (Deeble letter 5 July 1870, Add Mss 45775 f50).

In 1872, there was disagreement between Deeble and Nightingale on training at Netley. Nightingale held, as had Sidney Herbert, that it was impossible to train nurses at a military hospital. As she told Dr Sutherland, she thought it would be “absolute folly” to think of Mrs Deeble doing it (Nightingale etter 23October 1872, LMA HI/ST/NC 1/72/29/1, in 15:223).

 

Nursing in War: Zululand in 1879, Transvaal in 1880-81

11879, Deeble took six Netley nurses to the Zulu War, but there is little on paper about this expedition. Nightingale met with her prior to her departure and on her return, a meeting set for 10 June 1880 (Nightingale letter to Sir Harry Verney 9 June 1880, Ms 9008/62). Deeble evidently provided information, “allegations,” on the poor conduct of the orderlies (Nightingale letter to Sir Harry Verney 1 September 1880, Ms 9008/87).

In 1880, Nightingale was trying to ascertain what Deeble’s role was to be in training nurses. She asked Sir Harry Verney: was she to be “superintendent general” or the woman she, Deeble, had recommended, who was superintendent at the Herbert Hospital, Woolwich, She saw problems with nurses being under the “director general,” the head doctor, correct in “official” sense, but “in the practical sense, the very principle we most do combat” (letter 21 February 1880, 9008/22).

On her return from South Africa in 1881, Colonel Loyd Lindsay, head of the National Aid Society met with her and gave her some money for purchases at her discretion (Loyd Lindsay letter to Nightingale 2 February 1881, Add Mss 4806 f100).

In 1882, Deeble told Nightingale at a meeting that Dr Longmore and other Netley doctors “object altogether to any ‘London nurses,’ meaning civilian nurses. She thought “very little of your new N.A.S. (probationers) nurses,” she told Douglas Galton (Nightingale letter 8 May 1882, Add Mss 45765 f120).

On their meeting in 1882, Deeble gave a very negative report on the orderlies they had, who had only four months’ training at Aldershot, much in drill and parade, not nursing. If they do well as nurses, they should have a good conduct badge, with progressive increase of pay” A few were “good men,” but there were “a great many bad” (Nightingale notes 6 May 1882), Add Mss 45775 f90).

The Egyptian Campaign, 1882

In 1882, Deeble informed Nightingale that she had received orders to prepare a staff of nurses for service at the stations of Malta and Cyprus, a hospital ship, Carthage, for Alexandria, and Ismailia.:

I write to ask you if Mrs Fellowes would wish to join our party. I can take her as a government sister if she cares for the service and …. I shall be in London on Tuesday to arrange for outfits, etc., for the sisters; my time is very limited but I would like to see you on Tuesday after 6 o’clock for half an hour, as I may not again be in town before leaving England. Pray send me a word in reply to the care of T.D. Sullivan, Whitehall, goes by last train Monday (Deeble letter Sunday [July 1882], Add Mss 45775 f91).

In a meeting in August 1882, practical matters were the subject: stoves, mosquito nets, bandages, instruments—scissors, forceps, probes—capes, linen, rations. Mrs. Deeble had “sole control of the female nursing arrangements, under the local hospital superintendent” in their respective hospitals, subject to Mrs Deeble’s guidance..[They] send her monthly reports at to conduct of nurses, etc”. (Nightingale notes 1 August1882, Add Mss 45775 f f93).

Co-ordination continued between the two on the contingent for Egypt. Deeble herself would join it, Nightingale learned when meeting with the new director-general, Dr Crawford,[6] which information she passed on to Mrs Fellowes: “Mrs Deeble has offered to go. At present we have about 20 wounded (on board the fleet). Ramleh was occupied without a wound” (Nightingale letter to Mrs Fellowes, 25 July 1882 LMA HI/ST/NC1/82/8).

 

Extracts from letters from Jane C. Deeble, Add Mss 45775 ff78-83

R.V.H

13 February 1881

That Miss Caulfeild,[7] the superintendent of nurses at Woolwich, to embark for Natal on Tuesday, along with one of her sisters and two from Netley, /she herself will stay as per her duty. The P.M.O. will aid them as they need it. She feels bound to organise and work out the nursing under the auspices of the National Aid Society, which Miss Sheldon was unable to do.

Quarters have been enlarged and furnished at the expense of the government. Sir William Muir   and Colonel Loyd Lindsay wish the training not to be delayed.

Deeble saw problems with one or two points of the scheme but it needed to be tried. She hoped that in time the government would do more for female nursing, as the N.A.S. can only do so much.

Sir  W .Muir has always been supportive of our cause.”

Deeble thanked Nightingale for her good wishes, would inform her of how the sisters are when she hears, has not heard if the N.A.S. are sending supplies, she was made their agent (while up at Middleburg when taking in the Sick and Wounded for Secukuni’s engagement) and given money and kind for the sick, enabling her to get milk, eggs, chicken and pint, has ‘packed a Bullock trunk’ with supplies which may be used in an emergency or when government requisitions are difficult to get, in.” She is supplying a pocket Case with a thermometer, sub-cutaneous injection, and small instruments for each sister.

 

1883:

A Deeble letter om 1883 dealt with “female nursing” to commence 1^st June at the army base at Chatham, with National Aid Society sisters, by the recommendation of the principal medical officer and other medical officers of the Carthage, the hospital ship used in the preceding Egyptian campaign. “The D.G, Dr. Manly, who is senior at Chatham “is friendly to Female nursing in the Army” and approved of her, Deeble . She regretted to tell Nightingale that Sister Wheldon[8] was resigning, and hoped that the “stingy government” would give her a pension for her time (Deeble letter 5 May 1883, Add Mss 45775 ff111-12).

The bad behaviour of orderlies in army hospitals continued. An Enquiry was launched after the Transvaal War, to which Mrs Deeble gave evidence, along with such senior doctors as Dr Longmore  (Nightingale letter to Sir Robert Loyd Lindsay, 27 February 1883, Wantage Papers in 15:955).

1885:

Nightingale would have made Rachel Williams successor to Mrs Deeble both as lady superintendent at Netley and “superintendent general. In that same letter, Nightingale told the director general, that they were sending Deeble to report on the arrangements for 60 nurses at several proposed stations (Nightingale letter to Sir Thomas Crawford, 29 December 1885, Add Mss 45772 f69).

 

1892:

A letter after her retirement, Deeble wrote Nightingale one last time, from Netley Abbey, near Netley Hospital, asking to call on her when she went to London, about civilian nurses for India (Deeble letter 4 November 1892, Add Mss 45775 f113). The paper trail ends there.

 

African Wars: The Transvaal War (1880-81)

/The Anglo-Zulu War of 1879 (January to July) was sudden—a Zulu attack—but was over quickly thanks to superior British arms and equipment. No nurses were sent to it. Nightingale heard about the appalling hospital conditions by then Colonel Charles Gordon, later to be known as Gordon of Khartoum, who learned of them by his cousin, Amy Hawthorn whose husband was a fellow Royal Engineer. Nightingale would work with Mrs Hawthorn for many years on hospital conditions.

The (brief) Anglo-Zulu War was followed the next year by the Transvaal War, or First Boer War, of 1880-81, for which nurses were sent.

 

Amy Hawthorn: Introduction of a Whistle Blower

Born Amelia Enderby Dow (1842-1908), known here as Amy Hawthorn, married her husband, Robert Hawthorn, R.E., then a captain, in 1861. She, as an officer’s wife, visited soldiers in hospital, but was never a nurse herself. She carefully wrote up her observations, sent them to her cousin, who sent them on to Nightingale (Gordon letter to Nightingale 22 April 1880, in 5:492-93; Nightingale acknowledgment to Hawthorn, Add Mss 45776 f1, in 15:857).

Mrs Hawthorn was clearly a very able woman, but as an officer’s wife, she was not able to train or work as a nurse. She evidently did some nursing, informally, where she was allowed. Her most significant contribution to health care was her reporting on problems in war hospitals, especially the bad behaviour, even abusive, of orderlies. Nightingale encouraged her investigations, which in time resulted in her producing a comprehensive report raised in Parliament by Robert Loyd-Lindsay, president of the National Aid Society and then an Opposition MP, later Lord Wantage.

Hawthorn’s first letter to Nightingale was in 1880, from South Africa, at the Fort Amiel Hospital in Natal. The two battles referred to in Hawthorn’s following letter were the Battle of Schuinshoogte. 8 February 1881, and the Battle of Majuba Hill, 27 February 1881, both won by the Boers. The British commander, General Colley, was killed at Majuba Hill. It was the last battle of the Transvaal, or First Boer War, and is considered one of the most humiliating defeats in British military history. The Transvaal or First Boer War was followed by the Boer War of 1899-1902

 

Add Mss 45776 ff8-10 23, letter from A. Hawthorn, with FN underlining

Ft Amiel Hospital

Newcastle, Natal

23 March [1881]

Dear Miss Nightingale

I have often wished to write to you since I came here and one of your kind letters to my cousin, Colonel Gordon, forwarded to me by today’s mail, has decided me to send you a few lines.

I know your thoughts will have been much with the poor soldiers during the last sad weeks and you will be glad to know that the wounded are on the whole progressing favourably. Nearly 300 wounded have been here since the 28th January. We have only had six deaths. Of course at the Hill hospital at Mt Prospect there have been many more deaths in proportion, as the men were brought in there direct after Laing’s Nek-the Majuba fights and only sent on here after they had begun to improve. After the Schuinschoogte fight the wounded were brought in here direct from the battlefield and all the deaths but one have been among these. I was then the only nurse here, but two nurses from the Blomfontein mission arrived next day and were soon followed by a professional nurse from Maritzburg. I offered my services at the beginning of the war but they were only accepted by the medical officers when the long delay in the arrival of the Blomfontein nurses (owing to swollen rivers) made them fear they would not come at all. I received permission from the PMO to come upon Friday afternoon, left the next morning by post cart and reached Newcastle on Tuesday 8th February at 1 a.m. the very day of the Schuinshoogte engagement.

The hospital is composed of 10 huts containing 12 beds each, and a camp has been formed [illegs] tents and marquees for the less serious cases…….

My opinion of hospital orderlies has not been improved by a closer acquaintance, but [FN blue underline] of course there are bright exceptions here and there. I think the Blomfontein nurses have done good work here, but it seems a pity the Netley nurses were not sent out earlier when their services were much needed.

I am inexpressibly thankful that there now seems every prospect of peace and I should hope that in the course of 5 or so weeks all but a very few ill have left Newcastle. We hope to send off 60 convalescents in a few days and 50 are already on their way to Maritzburg; 40 of the worst cases are still at Mt Prospect.

The inhabitants of Natal generally have behaved most kindly and generously during this sad time, supplying us with fruit, puddings, etc., for the wounded and the Red Cross Association of Durban placed £100 at my disposal allowing me to use it as I liked.

1. Hawthorn

 

Because of the distance between London and South Africa, and ascertaining the exact location of the person in question, letters could take a long time to arrive. Hawthorn’s reference in the next letter to two letters received from Nightingale are probably one sent on the eve of her departure (Nightingale letter 4 June 1880, Add Mss 45776 f1, in 15:857) and one of introducing Mrs Fellowes (Nightingale letter 14 February 1881, Add Mss 45776f5, in 15:861).

Nightingale’s reply to Hawthorn said how “thankful” she was that she had found time to write from Fort Amiel. “My thoughts have followed you night and day (how I wish that I could have been with you) and blessing God for your work among the sick and wounded.” She had “doubtless” put down notes concerning the hospital orderlies, the food, cooking, comforts, equipment and other thing need for nursing the wounded. She had sent her material via Colonel Gordon about defects at the Portsmouth Hospital. She thought it would be of “immense importance” to get material on “the real state of the Fort Amiel and war hospitals” as to orderly nursing and the things which belong to nursing,” She asked for any notes she had made ((Nightingale letter 11 May 1881, Add Mss 45776 ff14-18).

Hawthorn evidently wrote Nightingale about the need for artificial limbs (letter missing) for Nightingale’s reply said that she would “apply immediately to Colonel Loyd-Lindsay, the chairman of the National Aid Society, for funds for ‘artificial limbs,’” and would mention it to Mrs Fellowes when she visited. Hawthorn had evidently also asked about training for war nurses, for Nightingale explained the need for civil training for nurses, not the plan of the National Aid Society, but she explained that military hospital in peace, and at home, gave inadequate experience in injuries and amputations—civil hospitals gave much more. (Nightingale letter 19 May 1881, Add Mss 45776 f18 in 15:872)

 

Add Mss 45776 ff21-22, letter from A. Hawthorn

Ft Amiel Camp

6 July [1881]

My dear Miss Nightingale

I have to acknowledge two letters of yours, which I was very glad to receive. I should have answered the first before now, but we are living in the camp and it is most difficult to accomplish much letter writing under the circumstances. I hope to send you the notes about orderlies and to answer all your questions fully in a week or two, but will only send a few lines by this mail in answer to your last letter of May 19th.

The man to whom you refer as having been treated in St Thomas’ Hospital was a gunner of the Royal Artillery and he was admitted in the spring of 1879. He was under treatment at the same time as Hugh Lamb, a sergeant, R.E., who was also sent up by us, most successfully treated by Mr Sydney Jones. I am very sorry I cannot remember the gunner’s name. I think it began with the letter G but I have kept no notes of his case beyond those I sent you. He lives in the same ward I believe with H. Lamb and this may help to recall him to Mr Jones.

I am grateful for the trouble you are taking in applying for artificial limbs for our poor wounded here. They will be invaluable to them.

I hear you have thought me very faint hearted about the Epsom Army Hospital orderlies. The truth is I do not see how anything is to be made out of such material. The want of conscientiousness I have seen lately makes me feel that nothing but constant and intelligent supervision will be of real use.

The Blomfontein nurses have done very well here–out of five, three were trained nurses. The other two were untrained and not suited for hospital work. I should say the Netley nurses are superior, but of course they vary and the two best have been in Newcastle. I must not write more today but hope to answer all our questions by next mail. The cold here is intense at night, 10 degrees below zero in our tents! With kindest regards, believe me

most sincerely yours

1. Hawthorn

 

Add Mss 45776 ff44-48, letter from A. Hawthorn, with FN comments

[printed] Government House

Cape Town

17 April [1882]

My dear Miss Nightingale

Your letter of 9th March has only just reached me as we have come down here for a few weeks. You can scarcely imagine how happy it makes me to hear of what you are doing [FN: how little] to obtain a reform in the hospitals. Out here it is all suffering or witnessing suffering. You clearly see how useless a mere official inquiry through commanding officers and medical officers would be, but if properly managed, the truth can easily be obtained. At this moment General Smyth has in his hands evidence given by men and non-commissioned officers to his own military secretary, which is stronger than anything I have sent you. Could not Mr Childers desire this evidence to be sent to him? I feel sure General Smyth will not do anything practical in the matter unless his hand is forced. He dreads “bother” more than anything else and the PMO in Natal, Dr Sinclair, is an obstinate, narrow-minded man who hotly opposes any interference in his own department. General Drury Lowe[9] (lately second in command) is here now on his way to England and he is horrified at the evidence now before him and promises me he will bring the matter forward at home, but we must not trust to that alone. Would you communicate with General Drury Lowe and also would not Mr Childers see him….

 

Add Mss 45776 ff69-76, letter from .A. Hawthorn

Pietermaritzburg

22 July 1882

Your letter of June 22nd (Add Mss 45776 f62, in 15:886) interested me deeply. I am very glad the enquiry is being made, but I cannot help being very anxious about the evidence and wondering if the written evidence I have sent from men of the Artillery, 41st and Dragoons can be used.

Dr Stokes, I fear, will not be scrupulous in what he says. I have reason to believe he made statements here that were without any foundation–I doubt if a clearer headed or stronger man than Colonel Buller could be found. Personally, I scarcely know him and do not know what his views are about the hospitals. I am sorry Epp is not inclined to speak, as I relied upon him. I wonder if you will have sent for Clark. I think he would speak, though he is nervous.

I am very glad you like both General Lowe and Dr Brown. The latter has had very little thanks for what he did out here and the other doctors as a rule are excessively jealous of him.

He was very much pleased at having made your acquaintance. General Smyth[10] got more evidence against hospital orderlies just before he left here, by last mail, for Capetown, but I don’t know if he is sending it home.

It will be a great point of old soldiers instead of raw recruits are taken for the A.H. Corps. Also the change as to pay and promotion for nurse orderlies would be admirable. But would there be no hope of getting orderlies attached to regts so that they would look upon the men of that regiment as their comrades and in matters of discipline would be under regiments’ officers? I suppose this would be too great a change to expect. Also, could you not urge that an orderly who has been found drunk twice should be sent out of the Corps? [FN red und] An orderly here who was tried at last by court martial had had 8 previous convictions for drunkenness [FN red und] in one year. Drunkenness is the crime in the A.H. Corps [FN red und] I cannot tell you how anxious I am to hear the result of the enquiry. I pray earnestly that they may find out the real truth.

ever yours

A Hawthorn

 

Add Mss 45776 Ff103-06, letter from A. Hawthorn, with FN underlining

Pietermaritzburg

4 December 1882

Private

Dearest Miss Nightingale

Your most interesting letter of the 2nd November reached me yesterday. How can I thank you enough for writing to me when you are so busy and telling me all that is being done about the hospitals?

You can scarcely imagine how deeply interested I am or how much I appreciate your goodness in writing. The outcry against the mismanagement of the sick and wounded seems so general that it can scarcely be hushed up, especially as on this occasion so many complaints are coming from officers and their friends, who cannot be silenced so easily as the private soldier. Some sad histories of neglect and suffering were sent me a mail or two ago by a friend whose brother was in Egypt and who had many friends there. I told her to write any account which was thoroughly authenticated to you and if possible to give the names of the officers concerned.

[Illegs]

Nothing of what you tell me is so amazing to me as there being provisions at [illeg] which nobody dared to buy while men were starving at the hospital. The dread of responsibility is one of the curses of the Service. It is only a man here and there like Colonel Redvers Buller [FN red und] who would dare to do anything without regard to personal consequences. Still I thought with a [illeg] from the PMO the Commissariat to buy anything that was wanted.

Your nurses seem to have been kept in Egypt and several at least of the Netley nurses sent home. Why? How simply invaluable nurses have been and how strange for me that they were sent. [llegs]

I don’t feel very hopeful about Admiral Edwards [?] as a member of the committee. I see his inquiry into the food supplied to patients on board the Malabar he says the books show they had sufficient diets [FN red und] !!! [Illegs].

 

Add Mss 45776 ff110-13, letter from A. Hawthorn

Pietermaritzburg

18 December [1882]

Dearest Miss Nightingale

We have just had a curious little difficulty here which – though now overcome. I must tell you about. It shows how helpless the jealousy of the medical officers often makes us. A young officer Lt Hudson 58th Regt was taken seriously ill 10 days ago. He was a friend of ours and he asked me to go and see him which I did. He was living in a house with three other young officers (all four boys about 19 and 20 and as he had no one to look after him but a soldier servant I offered to go in as much as was necessary and nurse him. He gladly accepted, but when I applied to the medical officer attending him (Dr Blackburn) he refused, saying he wished no one to attend Mr Hudson except his servant. This was on Monday–and on Wednesday he was so very ill that I saw Dr Thomson (the Med officer in charge of the hospital) and urged that I should be allowed to nurse him in his own rooms or that he should be moved to our house. I got no decided answer but the next day when I took down some chicken jelly for Mr Hudson I found he had been taken off in an ambulance – without a word to anyone–to the Military Hospital.

After a good deal of consultation, Colonel Curtis (of the 5th Dragoons) went up to the Hospital and found Mr Hudson in a miserable little room (that had been pronounced too bad for an office) and ascertained from him that he was still anxious I should go up but he was afraid of the doctor (Dr Curtis and Major Essex the DAAG) then went off and spoke to Colonel Bond (the officer commanding the 58th Regiment) and then colonel Curtis and I went off and saw Dr [ illeg] and I again asked leave which he granted providing Dr [illeg] (the senior medical officer) agreed. We went off at once to Dr [illeg] around ….

I only tell you all these petty things to show how impracticable the doctors are – how great the difficulties will be of getting any nurses allowed in the hospitals if there is an outbreak of fever. About 50 men are

v just going off to Zululand as escort to [illeg] and in all probability there will be a great deal of sickness but the doctors there would sooner every man died, I believe, than consent to have nurses. The PMO is at Capetown but Dr[ illeg] is the senior medical officer here. If there is a serious need I will telegraph to you and perhaps Lord Hartington may be persuaded to give an order instead of permission for nurses. I do hope he will take up the reform of the Department of the A.H. Corps. Believe me…. Mr Hudson is doing well. The illeg symptom disappearing.

P.S. Private.

I am sure you will feel that- apart from the nursing question –it was no small grievance that this poor boy should, against his own wishes, have been taken out of his own comfortable house and without a word to any officer in his Regiment, have been carried off to the hospital and put into a miserably small dirty little ward quite unfit for the occupation of any sick man. Notwithstanding the remonstrances of the Colonel of the 58th the doctors refuse to move him to a better ward, so we are making the best we can of this now and I shall try to get him brought to our house as soon as he is quite fit to move. The reason the doctors have against bringing Mr Hudson here at first was that at our house is an inconvenient distance for them to visit We live about 1 ¼ miles from the doctors’ house and they have 6 doctors in Pietermaritzburg and 50 men only in hospital with three or four exceptions all slight cases.

On Gordon’s death in 1885, by assassination in Khartoum, Nightingale sent Mrs Hawthorn a letter of sympathy (7 February 1885, Add Mss 45776 ff114-16, in 15:500). She invited Hawthorn to visit after the service for Gordon at Westminster Abbey. Nightingale and Mrs Hawthorn continued to keep in touch with occasional letters, notably from Florence, where the Hawthorns retired.

 

Add Mss 45776 ff325-26, letter from Amy Hawthorn [black-edged]

Grand Parade, Eastbourne

14 November [1896]

Dearest Miss Nightingale

Thank you so much for your kind letter (missing). All went very well at the funeral on the 6th. esp at the grave where the vicar read the concluding service very beautifully, and everything around looked peaceful in the [illeg]

The service in the church was disappointing. It was a cold unfinished building, partly of ironand the officiating clergyman stammered and gave a painful feeling of doubt and hesitation to those glorious assurances of immortality in 15 Cor.

I am not quite clear about Miss Irby, Am I right in thinking she is the matron of St Thomas’? I shall recollect about the matron in case I hear of one being wanted. I conclude for CD [contagious diseases/sexually-transmitted diseases] cases, specially. Is not the ward at St T. where those cases were treated now closed?

Oh those dreadful shrieking women with their testimonial nonsense! How impossible they are to deal with. I wish the[ illeg] can hope those acts might ever be viewed in England [?] India, without them, would be far far, far worse.

My husband wishes me to thank you very much for your kind message. The rest and change have done him good.

(Mrs Robert Hawthorn)

 

Add Mss 45776 f310-11, letter from Amy Hawthorn

9 Argyll Road

Kinsington

7 February [1893-94]

Dearest Miss Nightingale

Wednesday wd suit me quite well. As you know, it is the greatest pleasure to be allowed to see you, but I do not think you ought to be worried with the details of the Netley nurses work –night duty, leave of absence, number of nurses in Egypt, etc., when you are so much more unwell than usual. V I shall write and tell Miss Caulfeild that these masters must stand over for the present or they must fight them out with their Director General!

I hope Wednesday afternoon may give you a few hours rest and some day–when you are really better–do reward me for my self-sacrifice by letting me go and see you for a little while. The only business I have to speak about now is Miss Caulfeild’s and that must wait as it is really matters of historical organization in which I doubted your interfering.

3ver your affectionate

Hawthorn

Annie Ellen Caulfeild, Nurse at the Front

Annie Ellen Caufeild (1844-1937) was the daughter of the Hon James Caulfeild, of the Ceylon Civil Service, but was brought up by her uncle, the bishop of Nassau when the family was broken up on account of yellow fever. Caulfeild wanted to become a nurse and, after “strong protests” from her family, trained at King’s College Hospital. She nursed under Mrs Deeble at Netley then was appointed lady superintendent at the Herbert Hospital in 1877, where she served, with absences at war, until xx. In 1881, she was sent, to Ft Amiel, Newcastle. As her obituary pointed out, “This was the first time a staff of trained women nurses under the War Office had been ordered to the front.”

Her next war was Egypt, where British troops were sent to put down an Egyptian rebellion. Cauflfeild was quartered at thekhedive’s palace, Ismailia, which had been made over into an emergency hospital. Conditions were, as the obituary described it, “incredibly bad.” She was awarded the Egyptian Medal. She returned with wounded troops. She was awarded in 1883 the Royal Red Cross, at Windsor Castle.

Nightingale’s notes describe her “superintendent at the Herbert Hospital, one of Mrs. Deeble’s nurses, and  the nurses at Herbert were all four found by Mrs Deeble, except Kate Holland, who is still there .Medical officers perfectly satisfied with them. They are not in any way under Mrs Deeble” (note 30 April 1878 f1,  in 5:843).

 

Add Mss 45827 f78, Nightingale notes from meeting with Caulfeild

 

At Ismailia the ground was so soiled that Miss Caulfield could not pitch her tent.   It is the first fortnight that kills everybody. Clothes won’t be washed.

Unless England gives us men. At Woolwich (landing of wounded) things went wrong. close the Arsenal gates and  let no one see  was the order. I said open the Arsenal gates and let everyone see – [For everyone was talking about it.

 

3 October 1885, Add Mss 45827 f114

Margaret Augusta Fellowes: From General’s Widow to Professional Nurse

FN letters to roll3 15:851-52, 862-65 letters to 45806 f126 roll 3 82/38

Born Margaret Augusta Kirkland (1846-1931), daughter of a general, Mrs Fellowes married an officer who became General Fellowes and moved with him on his posts. He died  in 1879. In 1880,  she entered the Nightingale School, at age 34. Her training completed, she continued to nurse at St Thomas’, even as night nurse, the first “lady” to take on that job.

In July 1880, Fellowes evidently had a problem with her hand, which required time off. She wrote Nightingale from Leopold Ward, the male surgical ward, relating her intention to stay at Littlehampton, so that she might have to be an out-patient. She closed with “Miss Solly is writing that we are true nursing sisters helping each other in affliction” (Fellowes letter 25 July [1880], Add Mss 45806 f54).

In February 1881, Mrs Fellowes joined Sir Frederick Roberts’s force to the Transvaal, for which Nightingale wrote a letter of introduction. Nightingale sent her a case with surgical instruments as a departure present (her reply is the first letter below). Back from the Transvaal, she wreturned to Leopold Ward and became the ward sister.

Fellowes next went on the 1882 Egyptian expedition of Garnet Wolseley, returning in March 1883. She received the Royal Red Cross on the first, 1883, list.

In 1884, she married a surgeon at St Thomas’, George Makins (1845-1943), later Sir. She went back to nursing during World War I, in charge of nursing at the Hospital for Facial Injuries in London, Park Lane.

 

Add Mss 45806 f1105, letter from M.A. Fellowes

Yacht Club Hotel

Kingsmere

017 February [1881]

 

My dear Miss Nightingale

Just before leaving the hospital, Mr MacKellar brought the charming case of surgical instruments and really I don’t know how to thank you for so useful and beautiful a present. You really were too kind, though I accept my very best thanks. I hope as may have plenty of work and I know it will often make me feel that you are very near me. My father is with me and he sleeps here tonight. I am boarding a boat 10 a.m. tomorrow morng.

I did procure a stove [FN red und] after all, though a little larger than was authorized but Miss Caulfield’s is the same size. [illegs]

 

Add Mss 45806 ff126-29, two letters from M.A. Fellowes [black-edged]

Windsor Castle Hotel

Pietermaritzburg, Natal

23 March 1881

Dear Miss Nightingale

I saw Dr Holloway, the PMO, here yesterday and he wished me to go to Newcastle with some of the Netley sisters tomorrow,Thursday by Post cart. It is a little uncertain as the mail bags have been so very heavy with newspapers that the ordinary number of passengers (6) cannot be accommodate. Two of the sisters here were to have [illeg] yesterday though their places were secured they could not go after all, from want of room. Dr Holloway seems most kind and anxious to help me. I long to be at work again, being quite tired with my month’s idleness! He told me [illegs] having done a good deal of work. The hospital is at Fort Amiel, and though the wounds have been in many cases very severe, nearly 300 sick and wounded on the line. The deaths have been very few I impressed upon the PMO that I was one of “Miss Nightingale’s nurses and trained at her school.”

I hope I may have plenty of opportunity of showing them how thorough the training is and do credit to dear St Thomas’. I shall always think of my life there with much affection and gratitude. I will write again when I am well settled down in my work and can really tell you how I manage military nursing wh must be so different to civil. …

Pietermartizburg

27 March 1881

Dear Miss Nightingale

After all, I have not gone to Newcastle; the order being countermanded just as we were stepping into the Post [illeg] only one sister and Miss Caulfield have gone on. It is a great disappointment to me as I see no possibility of doing any nursing here and intend returning to England by the Mail of the 2nd in the ”Durban” if I can obtain a cabin wh is rather doubtful as I hear they are ove crowded.

The general (Sir E. Wood) rather wished me to stay here and intended sending down the wounded by degrees but the PMO (Dr Holloway) views are totally different. He and Sir Evelyn are not the best of friends and, if possible, Dr H/ [illeg] they the invalids shall not come and I see plainly does not want Dr Holloway and his rather “happy” at Sir E.’s telegraphic. So I fear I must do without[ illegs].

I hear Dr Holloway does not like nurses, but he talks to me as if he appreciated them! I was too late I think in coming–next time I shall know better.

I feel positive our poor soldiers little know the comfort of good nursing and I am told such wretched tales of their discomforts, how orderlies not changing the dressings, etc.

I do hope I shall see you when I return to be comforted! I see how badly the military wants good nursing and still all the “obstructing to in force! Military hospitals seem to contain such small scope for work in [illegs.] I will let you know directly I arrive in London. The Bishop of Blomfontein’s sister and Mrs Hawthorn have done all the work. Believe me

yours very sincerely

Margaret Fellowes

 

Mrs Fellowes and Nightingale continued to be in touch over the years.

 

Add Mss 45776 f310-11, letter from Amy Hawthorn

9 Argyll Road

Kensington

7 February [1893-94]

Dearest Miss Nightingale

Wednesday wd suit me quite well. As you know, it is the greatest pleasure to be allowed to see you, but I do not think you ought to be worried with the details of the Netley nurses work –night duty, leave of absence, number of nurses in Egypt, etc., when you are so much more unwell than usual. V I shall write and tell Miss Caulfeild that these masters must stand over for the present or they must fight them out with their Director General!

I hope Wednesday afternoon may give you a few hours rest and some day–when you are really better–do reward me for my self-sacrifice by letting me go and see you for a little while. The only business I have to speak about now is Miss Caulfeild’s and that must wait as it is really matters of historical organization in which I doubted your interfering.

3ver your affectionate

1. Hawthorn

 

References

 

Summers, Anne. Women as Voluntary and Professional Military Nurses in Great Britain 1854-1914. Open University doctoral thesis1985.

Times. Obituary. “Lady Makins.” The Times, 5 October 1931),

Times. “Miss Caulfeild.” 19 January 1937, 14.

BJN Feb 1937;

 

Enteric commonly used then for typhoid fever, a bacterial infection caused by salmonella, typically from contaminated water. Much affection displayed, but the letters contain a great deal of information, about the situation in the hospitals, reported confidently.

H

July 17/89                   [13:213-14]

 

The worst diseases were enteric fever, or typhoid fever, identified in 1880. “Remittent” fever was a term used, as was “continuous fever” on the basis of symptoms, without identification of a bacterium. Typhoid fever or brucellosis could be causes.

 

The Egyptian Campaigns, 1882 and 1885: Background

The Egyptian Campaign of 1882 was motivated by Britain’s concern to maintain easy access to India via the Suez Canal, which opened in 1869. The extensive rights Britain held in Egyptian date back to the Treaty of London, 1840, a reward for the revenues it provided for construction. The canal was operated by a private company with British, Frnch and Egyptian shareholders. In 1875, the British acquired majority ownership by purchasing Egyptian shares, but the khedive, or ruler, of Egypt in 1882 threatened access. The internal, nationalistic, Egyptian politics were complicated and ar  not described here (on this background see 15: 905-46).

On 20May 1882, a joint British –French fleet invaded Egypt and quickly took control. Bombardment of Alexandria began in 11 July1882 and the army then moved south quickly to Cairo, which was taken 15 September 1882. Britain remained in Egypt until 1956, leaving finally after the “Suez crisis” of 1954.

The Egyptian Campaign of 1882 shows a reversal of Liberal Party policy, which, under W.E. Gladstone, had been opposed to the aggressive “forward” policy of the Conservatives.

The commander was General Garnet Wolesley, who had been commander also in the 1876 Transvaal War and 1879 Anglo-Zulu War. Wolesley had told Nightingale that the army would be in and out of Egypt quickly, which it was, but then disease struck. Nurses who had been sent home were needed again. Some hospitals were over-staffed and well supplied while others lacked both nurses and supplies.

The Sudan Campaign in 1885 was prompted by different concerns: the taking of General Charles Gordon in Khartoum. The Liberal government was slow to act, but eventually sent an expeditionary force to rescue him, which arrived the day after he had been assassinated. Again, Egyptian politics are pertinent, for Sudan was under Egyptian control, while Egypt was a British protectorate. (see 15:964-1017). Gladstone was much disparaged for his slowness in acting. From being called “G.O.M.” for “grand old man,” he became “M.O.G.” for “murderer of Gordon.”

Nurses were not sent up the Nile, but were stationed at Cairo and Suez hospitals and on hospital ships.

It will be noticeable that, while the nurses had much confusion and reversals in orders to deal with, yet doctor-nurse relations were greatly improved from earlier wars, notably the Crimean War. Their services were uniformly wanted and appreciated, and camaraderie is evident. They travelled first-class, as did doctors.

That nurses, in 1888, were learning the local language, Arabic, is also noteworthy.

 

The most serious diseases at the time were cholera—a major epidemic broke out in 1883—and typhoid fever, the usual older name, often here called enteric fever. The bacteria that cause cholera had not then been identified, although the outbreak prompted serious research by the British, French and Germans. Typhoid was identified as a type of salmonella in 1880 by Karl Joseph Eberth. Of course identification did not lead to cure. The breakthrough in cholera came soon after, and the bacteriologist who made the discovery, in India, Robert Koch, had been in Egypt in 1883.

Sybil Airy was the main correspondent on the 1882 campaign, Rachel Williams for the 1885.

 

Preparation for the 1882 Campaign by the Army Medical Department

 

Add Mss45772 ff5-6, letter from Dr. T. Crawford[11], with FN red underlining

26 July 1882

Private.

Dear Miss Nightingale

Thank you very sincerely for your note. I have submitted recommendations to send nurses to the base hospitals to be opened at Malta and Cyprus [FN red und] and, if Mrs Fellowes would accept employment in either of them, I shall have pleasure in putting her name forward as one of the ‘sisters’ to be sent out. We do not at present contemplate sending nurses to Egypt [FN red und] as it is proposed to illeg the sick and wounded from the sphere of operations to the above-named stations as expeditiously as possible. Believe me

your faithful servant

1. Crawford
2. I see I have not replied to your PS. Mrs Fellowes need not bother to send a formal application.

 

Add Mss 45772 ff11-12, letter from T. Crawford

[embossed red crest] War Office

4 September 1882

Dear Miss Nightingale

I am in receipt of your note of 31st. A further number of nursing sisters leaves for Ismailia as soon as we can make the necessary arrangements. Miss H. Norman will be included and will probably proceed to Ismailia by an early mail steamer. The nursing sisters will be travelling as first class passengers on board the Hospital and other ships.

No special ration beyond that normally issued in the field has been named, but the sisters have the option of drawing the nursing allowance should they prefer doing so.

We have very satisfactory accounts of health and hospital arrangements up to date. Believe me, dear Madam

your faithful servant

1. Crawford

 

Add Mss 45772 ff15-16, letter from Dr T. Crawford re enquiry Transvaal move to army3?

[embossed red crest] War Office

18 October 1882

Private

Dear Miss Nightingale

I have not been able to reply to your note of 14 October (in 15:988) sooner. Even now I cannot answer fully the questions you ask.

The enquiry with the A.H.C. [Army Hospital Corps] has not been abandoned. It was postponed on my suggestion, because I did not think it desirable to hold such an enquiry when the greater part of the Corps was absent on active duties.

I will now,I believe, proceed and now have some other points in regard to which we have heard much lately. I cannot yet say what is to be the precise constitution of the committee but I can urge that it the committee shd be an independent one and that it shd take up the whole questions of nursing in times of war as well as during peace.

I shall have great pleasure in waiting upon you on your return to London. Believe me

your faithful servant

1. Crawford

 

Sybil Airy: Introduction

Sybil Airy (ca. 1841-1918), was age 30 on entry to the Nightingale School in 1871. She subsequently became sister of Leopold, Ward, then Albert Ward, then lady superintendent at York County Hospital in 1879. She nursed for some seven years in Egypt, beginning with the Egyptian Campaign of 1882. There is much surviving correspondence from her in Egypt, but no letters from Nightingale to her, for any of her appointments. Post-Egypt, she was matron of the Royal Victoria Hospital, Bournemouth. Airy was the daughter of a Yorkshire vicar and niece of Sir George Airy, the astronomer royal.

Airy and Nightingale first met in 1876 (Nightingale note 20 January 1876, Add Mss 45775 f116). In 1879, they met again, when a position at Oxford in district nursing was a prospect. Nightingale reported to Dr Acland of Oxford on her interview with Airy, then “Sister Albert” at St Thomas’, that “if she could be called ’training lady nurse’ or ‘training head nurse’ (to satisfy her family’s objections), and if she were empowered not only to nurse in the district herself, but to train and supervise the nursing of other nurses at the poor people’s own homes, she would come to you,” She would not merely as a “head nurse” (letter 8 May 1879, LMA H1/ST/NC1/79/31 in 13:768). Airy did not leave her position as “sister” at St Thomas’ until she was made superintendent at York County Hospital.

Airy joined the expedition to nurse in the Egyptian campaign of 1882, and sent Nightingale numerous letters from Cairo on the work, the problems they faced and the wider political and military context. When she left for Suez Nightingale described her to Mrs Cox as a “first-rate male surgical nurse,” and “disinterested enough to give up a “well-paid matronship” (letter 2 October 1882, LMA H1/ST/NC1/82/32 in 15:935). She went back and forth a number of times. She was shipwrecked in 1887 on a final trip, but rescued.

In 1899, Airy wanted to go to the war in South Africa, Henry Bonham Carter told Nightingale (Bonham Carter letter 5 November 1899, Add Mss 45775 f200). However, there is no material to indicate that she did.

Airy is the main source here and her letters give fine descriptions of the challenges the nurses faced: the large numbers of patients, severity of cases and difficulties with drunken orderlies

 

Airy letters from the Egyptian Campaign, 1882-83

The great bulk of Airy’s surviving correspondence is on her first posting there, in 1882. Nightingale liked and quoted from her letters, which were “cheery,” despite their content. She was pleased that Airy had “done such splendid work among the enteric cases, who need, as doctors themselves now say, more nursing than doctoring, (letter to Mrs Fellows 1Decembet 1882, LMA H1/ST/NC/82/38, in 15:947).

 

Add Mss 45775 ff119-20, letter from Sybil Airy LM [check for words, abbrevs]

c/o P.M.O. The Citadel

Cairo

18 and 23 November 1882

My dear Miss Nightingale

A thousand thanks for your dear kind letter received on the 16th inst [this month] [missing] which seems to have given me fresh vigour to combat against our many (many indeed!) new difficulties here. There are nearly 400 patients in this hospital and things are in fearful confusion (and we find some patients have got bad bedsores alas!). We are all inclined to be downhearted, but no, that will never do for the cause if we are! So I think you may trust us to be as brave as we can. ….

General Hawley, who was round the hospital the previous day and looked at the cases, asking questions, and kindly enquired which sister she was, said he had heard of her from her. He told me he had heard of one from you. I am a little more reconciled to this hospital than I was 5five days ago. Still. I am afraid I never go to bed here satisfied with so many patients (and some tiresome orderlies). I come off duty feeling I have left many little things undone.

And the military nursing is so different in many ways to civil hospital nursing, for military doctors let their patients do such unheard of things! I began to make a few notes for you but have had no time to continue them. At present here it is not a matter of working and backwards and forwards on our wards. Our quarters are here in the hospital (a grand old Palace) Sister Forrest’s and my bedroom opening into a large ward. I have a division of almost 84 beds including the sick officers’ ward. Sister Cannell has another division (containing more beds) and Sister Forrest another division. Mine is the centre division. Sister Yardley is on night duty. I enjoyed my night duty at Ramleh very much.

We came here last Friday and, from what I see and hear, I should think we are likely to remain here months. Goodbye and continue to pray and think of us.

yours ever

Sybil Airy

 

Add Mss 45755 ff121-24, letter from Sybil Airy LM

The Citadel

Cairo

31 December 1882

My dear Miss Nightingale

I do not know how to thank you enough for your most kind letter and beautiful card received on the 29th inst [this month] [both missing].You do not know what good your letters do me–only I am not half worthy of them I am afraid.

8 January 1883

This will just show you that I did try, had tried to send the letter a week earlier, but had not enough time to finish, after duty they either go out for some air or they get interrupted by callers when writing letters, e.g., Lady Alison, Mrs and Miss Floyer, Sisters from Abbâsiyeh, etc. The Gozo Sisters you enquire about all went to Abbâsiyeh, except Sister Lee, who came to help us here. She shared Sister Forrest’s large Division and was a great help until, poor girl, about 10 days ago she fell ill herself with enteric fever and has been in bed ever since. Sister Thomas from Abbâsiyeh is here solely to nurse her. We hope she is rather better today, but her temperature daily ranges from 102 to 104.6.

I have never happened to meet Miss Norman –she called upon Sister Cannell the other day, but I knew it not until after she had gone. Dr Barnett, the P.M.O. here, left us a fortnight ago for a meeting in London, but he hopes to be back here in another fortnight. He has been a good friend to us, we seem quite to miss him. Dr Tanner is acting for him in his absence. The fresh enteric cases continue to pour in daily. One of my cases died on Christmas Day (the first death I had had since we came here) and I much fear I may have lost another one in 24 hours, and as a last resort the Doctors have put him on Champagne.

Three weeks ago, I actually got a surgical case in my Division! Amputation of a leg from a railway smash (I almost began to fancy myself at dear St Thomas’) brought in at midnight and operated upon at 11 a.m. next morning. The operation and after treatment were very different to what I had been used to at St T, however all went on fairly well with the poor man until New Year’s Day (17th day after operation), when hemorrhage took place at 4 p.m. and could not be stopped before 9 p.m. Of course this threw the poor man back a good deal, but he is picking up now, I am glad to say. He is Reserve man and was on his way to Alexandria to join a ship for England when the accident happened: he had been drinking and jumped out of the train.

How fearful is the intemperance of the orderlies! especially at Christmas-time. I am thankful that Christmas is over on that account, not but what one of my orderlies tonight had to be taken off the ward room, I am sorry to say. Does it not seem dreadful that these intoxicated people should have charge of the sick? I am afraid many of the A.H.C. [Army Hospital Corps]  are a bad lot, from what we have seen and heard. I hope you won’t mind what I am going to say, but really I cannot get reconciled to military nursing, it is so unsatisfactory. I am constantly wishing for what you said I should: 4 pair of eyes!

Is it true that Miss Solly has gone home without waiting to return in the Carthage? I wish you could get me some more of those “Soldiers’ Manuals” to give to some of our poor men here, if you should have an opportunity of sending a little parcel by anyone coming out?  I have long parted with those you gave me and they were much appreciated.

I should like to have peeped in in at Home Sister’s Xmas decorations on Xmas Eve–she told me a little about them. You may be sure I thought about you all. It is just commencing to get cold here- everyone goes about shivering and wishing for what we never get in Egyptian houses, a fire. And the leaves are beginning to fall. But the days are still bright and sunshiny. With fervent love and New Year’s wishes and trusting you are feeling better than when you last wrote, I remain

ever yours

Sybil Airy

 

Add Mss 45755 ff125-28, letter from Sybil Airy LM

Citadel Hospital

Cairo

Monday, 19 February 1883

My dear Miss Nightingale

My heartiest thanks to you for your dear letter of the 9th inst [this month] [missing] received last Friday and for the enclosed little books which accompanied it. You wished that you were out here with us–truly do I echo your wish, for we seem in much need of a Chief here. Still, it is sweet to feel and know that you are with us in spirit. I often feel that it must be the prayers of friends in England that keep us from flagging. How good and kind of Sir Harry Verney, etc., to remember your children in that particular way. I am beginning to wonder how long we are likely to stay in Egypt. I suppose even you have no idea? The great drawback of Egypt is the fleas and other disagreeable insects. The weather is still very bright and beautiful, but the nights are somewhat chilly.

The sick sisters are progressing I am glad to say. Sister Lee got up one day last week for the first time in 6 weeks and she has been out for her first drive today. Sister Cannell who has had both inflammation of the lungs and Enteric fever is still very weak. Sister Forrest seems out of breath just now. But Sister Yardley and myself keep in excellent health, I am thankful to say. Being short of hands we have been obliged to do without a night sister. This last fortnight, the severe cases have begun to lessen considerably, consequently, we not now feel at all over worked, for a long time I have had 30 or over 30 temperatures to take of an evening, but now they have dwindled down to 19.

Of course I still have some rather bad enteric cases in my division. And for more than a week I have had one very grievous case on my hands, a Captain Mortimer, suffering with pleuro- Pneumonia and hepatitis. He was frightfully delirious for three days and was it not a dreadful responsibility for me when Dr Wilson told me that it depended upon the nursing whether he would pull through this bad attack? This day last week was the night of his crisis and you can well imagine my anxiety–having no night sister, I stayed up until past midnight to look after him (for one had to give such frequent nourishment). You can well imagine my thankfulness the next morning when he woke up sensible after 3 fearful days and nights of delirium. Dr Wilson seemed so overjoyed and thankful when I met him the next morning and told him the patient was better.

Two days ago Dr Wilson said so earnestly and quietly to me, “Sister, you may take credit to yourself for having pulled Captain Mortimer through.” I said, “No Sir, it is due to having been such a good patient,” good and obedient and he puts such implicit faith in me that I can get him to take anything! He even said, “ if I wished him to drink a bucketful of anything he would do it at once, for he knew it would be right” (!) poor man! I fear he is not out of the woods yet–his temperature is going up again today. Dr Wilson (Surgeon-Major) is the nicest and I have come across among the Army doctors, I quite valued his little encouragement the other day, for it is so seldom that these army medical men never give one an encouraging word. And today he asked me to take a pulse and respirations for him, so that shows that he can trusts the sisters!

I lost one case of enteric fever last week, with lung mischief as well, I am sorry to say. That made the 7th death I have had here and I had six at Ramleh.

How very nice the soldiers are to nurse! (with the one exception of their nasty habit of spitting on the floor, which we cannot break them of! and how very terrible the drinking propensity among the orderlies is!) One quite dreads “Payday” for them. And oh! how thankful we were when Christmas was over, for so many of them kept getting into trouble then. In the same ward with Captain Mortimer, I have one other patient, such a contrast to him, for he is without exception the most tiresome and self-willed patient I have ever had to deal with. He is one of our young doctors here (Dr Osborne), who is ill with enteric fever. To judge by him, truly doctors make the worst patients!

I am so glad to hear that Lady Verney is somewhat better. You must have been so anxious about her. I trust you are keeping fairly well yourself.

I am thinking that the Carthage must be just about arriving home? I fancy Mrs Fellowes will be very glad to be home again. Such a quantity of our patients went home in the Carthage;  the amputation case was one of them.

Give my love to Matron please, and tell her that, if our work keeps a little slack, I shall soon hope to answer her Christmas letter. The days fly by here! I can scarcely realize that we are almost two months past Christmas. I do hope we shall manage a peep at the Pyramids before we leave Egypt. I should not like to go away without visiting them. We can see them in the distance from here (6 miles off). I have not written half I want to, but must stop now it is getting so late.

I was so interested in all the news you tell me, abut St Marylebone Infirmary, etc. Again thanking you for your many kind letters.

with fervent love, believe me

your affectionate child

Sybil Airy

 

Add Mss 45775 ff129-32, letter from Sybil Airy LM

Citadel Hospital

Cairo

15 May 1883

My dear Miss Nightingale

I have never thanked you for your kind letter of 23 March, [missing] with all its good Easter wishes, which were very precious to me. It is nice to think that you know Cairo, and that you can fancy exactly where we are. I heartily wish you could see the Citadel now, or rather this Citadel Hospital, for, although some things about it are not all one could wish, such grand old chandeliers, cornice, etc. which only accommodate dust and rather too much old woodwork in the place), still it is at last in a thorough, straightforward, good working order, very much different from what it was this time six months ago! We only have about 230 patients at the present time, so you see we are not heavy and only a few of them are really severe cases These are chiefly pneumonias. We have a few cases of enteric fever but not of a severe type as formerly.

Of course, at times we still have our little trials, with the orderlies and non-commissioned officers, but chiefly with the latter. I really cannot see why there need be any corporals in the wards at all! They are almost without exception a perfect nuisance! They only seem to take a lively interest in their wards just as the doctors enter them, and then put themselves forward to answer questions, which they really know nothing about. When this is the case, some of the doctors, who appreciate the sisters, administer some awful snubbings! Which certainly do them an immense deal of good.

Our  head here, Surgeon-Major Tanner, is very good to us in a way; still, we all fancy he does not uphold  much as his predecessor, Dr Barnett, did (who, I believe,  is now at Woolwich). He was good to us! And he kept such capital order in the hospital, which lasted all day, not only during the morning. We missed him greatly when he left us two months ago. He said “when he was appointed to a fresh hospital the first thing he should do would be to apply for a staff of “sisters.” Directly he went, the whole tone of the hospital seemed changed; he had such a good influence over the Army Hospital Corps.

What aggravates me so much is that ,because an orderly possesses a “good conduct stripe,” he is supposed to be a thorough nurse and is sent up to take charge of a ward with many anxious cases  in, when  he is the most unfitted man possible for the post! And does not take the slightest interest in his work, and has not one atom of a nurse in him!

I can’t tell you how much we sisters long to weed out the orderlies! Some are really good workers and so willing and pleased to be put into the way of doing things properly that it is a pleasure to work with them, while others are totally unfitted for the work and give one the idea that they have really joined  the Corps on account of the “good pay.” Moreover, in their own eyes they know everything when really they know nothing with regard to nursing.

We do not know when the next mail leaves, however, Sister Cole is not with us now. She was told off for work at Ramleh, a fortnight ago. So we have again four sisters here: Sister Cannell (who is very nice and so softened down since her illness, I say this privately you know); Sister Yardley; Sister Armour and myself. Sister Yardley and I shares a bedroom overlooking the Tombs of the Khalifs, towards Abbaysieh and over the desert, and from my bed  I can watch the long strings of camels going to their work across the desert. This bedroom is right away from the rest of our quarters, to get to it we have to go through the wards or rather two divisions.

I am so sorry to have to tell you that I have myself been on the sick list for the first time since we came abroad. It is just a fortnight since I was on duty, and although nearly ready again now, Dr Wilson says I must still take a few more days rest. He is going to put me on tonic today. It is a slight attack of dysentery that I have had to give in with for which I had to keep to bed for five or six days and be dosed with Ipac: quite a new (but not very pleasant) experience for me this attack! I shall be able to feel all the more for my poor patients.

When I had to take my bed, Sister Cannell kindly let me go to her room, which is next our sitting room, for mine and Sister Y.’s rooms is too far off to be near our little conveniences. The attack began with ordinary diarrhea a fortnight ago last Thursday, but often having had that before, I only dosed myself with usual remedies for it, I felt out of sorts that I had to give in and have Dr Wilson see me He is very good to me, and is very careful of me. This attack made me feel dreadfully weak but I am daily getting stronger, I am glad to say, and hope to be on duty again shortly.

I now go out for a drive in the evening. It begins to get very hot now in the daytime. I am wondering how you are and whether you are in London? And how everyone at St Thomas’ is? Give my love to Matron and Home Sister when next you see them.

I wish this was a more interesting letter for you. My thoughts often go across the Mediterranean to you all.

your ever affectionate child

Sybil Airy

 

Add Mss 45775 ff133-37, letter from Sybil Airy LM

The Citadel

Cairo

4 August 1883

My dear Miss Nightingale

We do not know when the next mail leaves, however I am going just to write a few lines whenever I can find time, in readiness for it.

Very many thanks for your kind and cheering words received yesterday. I am indeed glad and thankful that I had not gone home when this cholera broke out. It is quite a privilege nursing the poor cases! We have lost 22 cholera patients here (I was with eight of them, when they died) and we have about 14 convalescing ones. The cholera news today all round is very cheering; it is certainly fast on the decrease, I mean the cholera.

Do not trouble anything about the telegram now. We can settle that when I come home. I was with one of the poor dying officers (Lt. Croft) when I received it. Thank you also for the Medical Times which is very interesting. The lecture you point out is delightful. For the last 11 days, we have scarcely had a moment to ourselves, for reading or anything else, just now¸ there seems a sort of lull, just yesterday and today still plenty to be done, though not the press of work we have had. Sisters Yardley Armour and myself  are dividing the work as evenly as we can at the Cholera Hospital. For a week, I was on day duty there entirely, gong at 8 a.m. and returning to our quarters (which we have had to change) at 9 p.m., just running away at 1 p.m. for dinner (not for tea). Now we three sisters take 12 hours of alternate day and night duty. It is my night for duty tonight.

Sister Cannell looks after everything generally and takes charge of the non-cholera patients. We have lost five of our Army Hospital Corps men. One of them was one who was helping me nurse the officers, and was suddenly seized one morning at 3 a.m. and was dead in, I think, less than 12 hours.

We sisters all keep well, I am thankful to say, and are all in capital spirits. I am sure all your prayers at home keep us up and help us in so much. It is so sweet to know that our friends are thinking of and praying for us, and our patients at home.

I am very sorry to hear of Mrs Fellowes’s poisoned finger. I hope she will get better in the sea breezes, but I fear it may be long before she is able to resume her work.

While at the Cholera Hospital yesterday afternoon, I was surprised by a visit from young Dr Acland[12] of St Thomas’. He has come out, it seems, to work among the Egyptian Army. He brought me news of St Thomas’ and he also told me about Mrs Fellowes. It was quite nice seeing an old face fresh out from England!

Sunday 5 August [1883]

All going on favourably today, thankful to say. Our patients all better, had a tolerably quiet night with them last night. No deaths, no fresh cases in. The poor things all getting so painfully hungry now! You know how very careful one has to be in feeding them, a very little at a time, but often. Well, they are beginning to get so hungry now that they feel almost injured at their treatment. How I have wished you could have been here on the spot with all your great experience to direct our working. I do so agree with what you say with reference to a cholera epidemic: if there is to be one it is indeed nice to be in it. We have had to leave our quarters in the old Palace while the whole place is undergoing sanitary work. We have ventured into the vacated Officers’ Mess, etc., close by, in the court yard beyond the Palace.

The mail leaves this evening, so I must soon close this; I wonder when it will reach its destination, not for a fortnight, I fear, now that the letters have to undergo quarantine. Well, everything around has a cheering aspect today: the disease in Cairo greatly on the decrease .And the cases not of such a severe type.

We and the doctors here all keeping well. A Dr Lewis, we worked with at Ramleh, has died from cholera. (I cannot remember at what place) we are sorry to hear. He was a careful, hard worker, among the enteric fever cases at Ramleh.

We can see from the windows that the grand old Nile is rising higher and higher everyday now. My love to Matron and all old friends at the dear old Home (St Thomas’). I hope Home Sister is enjoying her change and rest. Oh, how much she would enjoy being out here! At least I fancy so. Not that she could be spared from her present post, I well know that. Trusting you are keeping tolerably well, and with truest love, I must wind up for the present.

your ever affectionate child

Sybil Airy

Quite forgot to say that we (three of us here) are in possession of our crosses. General Stephenson,  accompanied by Colonel Ardagh, the Surgeon-General, and one or two others, came and presented them to us in a quiet way one evening last week (it was our wish not to have a show and fuss over  the presentation, and particularly just at this present bad time. Once more, farewell.

 

Add Mss 45775 ff140-41, letter from Sybil Airy

Citadel Hospital

Cairo

30 October 1883

Dearest Miss Nightingale

Very many thanks for your kind letter of the 5th inst [this month] [missing] and the Times, which followed it in a few days. I was very pleased to read Dr Acland’s nice address to the students at King’s College hospital and I was also interested in reading about the Church Congress.

We see young Dr Acland occasionally; we were over at Abbaysieh to see his hospital last Friday, for he had asked me to come over show his people how to pad splints properly. In such a short time and under many difficulties, it really is quite wonderful how beautifully he has organized the “Bed Hospital.” We were over there about six weeks ago–then it scarcely looked like a hospital, now the wards, kitchen, dispensary, laundry, etc., are in beautiful working order, with quite a tone of “St Thomas’” about everything, quite delightful to see in Egypt! They could not make beef tea when he first went there, so he wrote off to me at once asking me for a recipe, so I wrote down for him the way we used to make it at St Thomas’, which recipe he had translated into Arabic for his hospital cook, who now makes it splendidly. The cook seemed very proud indeed of the beef tea and made us all taste it! There were as many as 120 patients there last Friday and most of them seemed very comfortable. The khedive had visited the Bed Hospital the previous day and had expressed great approbation with all the arrangements. And he promised to send them a quantity of orange trees, etc., to plant the garden with, from his own grounds. Dr Acland must have worked very hard to have completed so much in such a short time.

The hospital here is tolerably full, but not with very many serious cases, scattered over the different divisions. I think we have 7 with enteric fever. One poor enteric who had had severe haemorrhage died on Sunday in one of Sister Cole’s wards. I suppose Sister Winterton [FN red und] is home by this time? I did not hear that she was going until she had already started. I cannot tell you how sorry I am that she resigned; it has caused many unpleasant little things to be said against us (sisters in general). I was in hopes she would brave everything. [FN red und]

The Surgeon-General called upon us a few days ago on purpose to present us each with a copy of a letter he had received form the Director-General referring to our work (which was only doing our duty) during the late cholera [FN red und] epidemic. If I have time I will enclose you a copy of our copy, to see. I believe Dr O’Dwyer (who is now head here, and who all along has been so favourable to sisters) spoke a word for all of us and Dr Wilson specially for Sister Armour and myself. Sister Cannell is doing the night work just now. How deeply interesting is “Lord Morley’s Report,” we have all been perusing it. Sister Yardley had that large blue book sent her by post. Alas! A certain “Orderly George” mentioned in it is in this hospital—we all know him too well. We were told not long ago that he was dismissed [FN red und] but he still keeps appearing and is even on duty tonight in the “Right Wing.” He is not to be trusted to do a single thing, wretched man!

We are all [Airy und] keeping quite well [FN red und] thankful to say. And now are quite climatized [Airy und], we all have been in Cairo [Air und] a year on the 17th Nov. How the time has flown by!

I am so sorry to still hear such bad accounts of Lady Verney. My love to Mrs Wardroper, Home Sister [FN red und] and old friends.

your ever faithful

Sybil Airy

[at top]  our Bull’s Eye Lantern has been so useful to me. I don’t know what I would have done without it at the Cholera Hospital It was most [Airy und] useful.

 

Add Mss 45775 ff144-47, letter from Sybil Airy LM

Citadel Hospital

Cairo

31 March 1884

 

Dearest Miss Nightingale

Thank you over and over for your most welcome cards of March12th and 14^th [missing] (both received on the 20th), and the 21^st the latter I got last Thursday the 27^th. I had been so longing for just a word from you. How I feel quite set up again. Even if I had not heard from you, I knew we should all be in your thoughts. I shall be pleased to receive the little pamphlet about General Gordon you mention.[13] I want to learn something more about him, he is a grand man. Altogether I think we had 147 sick and wounded in from the Front.

Tomorrow I believe we are to lose some of them, at least those who are fit to travel belonging to the 10^th Hussars and the 85^th. I think they are to join the “Jumna” [?] at Suez for England. My two officers are also going, Captain Littledale of the 85^th, who had 4 spear wounds and 2 bullet wounds in his left shoulder (all healed now except the bullet wounds) and Lieutenant Gordon of the 42^nd with bullet wound of right arm, not yet healed, but doing well.

You will hardly believe it when I tell you that, among all our set of wounded (and oh! How I have longed for more surgical work!) these are the only two cases I have had the privilege of looking after. My Division has the floors boarded [Airy und] unfortunately rather an unwholesome looking floor, while the Right and Left Division have nice cool, clean, stone slabs. So Dr O’Dwyer had all the medical cases from the Right Davison transferred to me and left that quite  empty to receive the wounded, so Sister Yardley [Airy und] came in for all those. I think among them there is rather a bad bullet wound of right wrist, which may have to be excise. The poor man was very delirious for several nights after he first came in. Well, then I thought of course Sister Cannell would put me to look after the wounded in the Left Division and sounded hr upon the subject, but  no, it was not to be! She said she could not think [Airy und] of taking me away from the centre Division, so she took charge of it herself as well as she could considering she is Night Sister. When Sister Armour returns (and we expect her in a few days now) I suppose she will be put in charge of the Left Division.

I believe that three other sisters are also expected to arrive by P.&O this week. Sister A. is coming alone, in the Tyne. Although I have not the great privilege of having many wounded [Airy und], I prize several of my cases as having been at the Front, namely, two enteric fevers (one a nice Marine) and some sunstroke cases. One of the latter was seized on the day of the Battle of El-Tebir and managed not to give in then, but the next day he fell down insensible and remained so for 3 days. Poor, brave fellows! I have had several interesting battle talks with them, even with some of the wounded, though I am not [Airy und] nursing them. Never mind! The work is sweet whatever it is, whether medical or surgical, and one cannot always have what one wishes for.

But for a moment when the poor wounded trooped up my staircase with their guns (and a few spears) in their hands, some singing and some on stretchers, and were motioned off  to the Right and to the Left Davison, I did [ und] feel a little [Airy und] disappointed. But I soon shook that feeling off when I found I had to help Dr McNamara dress the two officers’ wounds: my spirits rose at once!

Amongst my cases, I have a very severe laryngitis, who was at the Front; his temperature has been over 105 and often 104 and 103, but he is coming down to normal now. So much to do for him. This last draught of orderlies from England on the whole is not [Airy und] a very good one perhaps there are about six of them tolerably good, but the rest want constantly looking after and keeping up to the mark. All from Woolwich [Airy und] make such notoriously bad poultices! And seldom  think of clearing away the dirty basins, etc. Two or three of the sergeants who came with them are capital, wardmasters, and know their work well.

I, unfortunately, have a very noisy-voiced [Airy und] one for my wardmaster, he shouts most unmercifully! The sergeant-major has had to speak to him about it.

We get an immense number of lady visitors to the hospital just now, bringing flowers, oranges, books, newspapers for the wounded men. Mrs Baker was here the other day laden with packets of tobacco for the men, from General Baker.

I think I told you last week of the death of poor Colonel Synge. He was a hopeless case from the first; had been ill nearly a year. Sir Benson Maxwell and Lady Maxwell were with him when he died, they were related to him and often used to come and see him. We sent for them when he was getting worse the morning of his death, as also dean Butcher. The funeral was at 5 p.m. that same day, and was well attended—he was so much respected.

We have had tiresome and constant changes here with the doctors lately. One of my wards has had no less than 5 different doctors in one month. We hear that nearly all our troops are coming back from Suakim next Thursday: that will be quite a day of rejoicing. We have received the sad news here of Prince Leopold’s sudden death, what a blow it will be to the poor Queen and his young wife if she was not with him.

I was so interested in all the St Thomas’ news you gave me. But sorry to hear such a bad account of Matron’s health and very sorry to hear of Home Sister’s sorrow. My love, please, to all old friends. I must wind up now, it is getting so late, although I do not think I have said all I intended.

yours ever faithfully

Sybil Airy

 

Add Mss 45775 ff148-50, letter from Sybil Airy LM

Citadel Hospital

Cairo

Easter Day, 13 April 1884

Dearest Miss Nightingale

Just a note to tell you “all is well.” While that continues to be the case, I shall not write as often as I have in the last 6 weeks. Indeed, I have sometimes been a little afraid that my frequent letters lately may have rather worried you. Still, I felt you would like to hear of us as long as the recent campaigning lasted; now [Airy und] that is finished and the troops have returned. And our poor sick and wounded are all on the mend. And most of our old doctors are back again here. And everything and everybody, after all the late excitement, is settling down to the usual routine of work. The smallpox case I told you about made a good recovery, and we have had no fresh cases since. I have three enterics now, all doing fairly well, but two of them are rather severe cases. There are about 68 patients in my Division now. Another sister is sharing it with me, for two more sisters from Netley joined us last Thursday, Sisters Burleigh and Irving. The former is sharing my work. They both seem nice, I think. They came out a party of five, but three of the sisters were dropped at Suez for duty thee, which enable two of the old ones to return to Ramleh. So, at present, there are six sisters here, four at Suez, and two at Ramleh.

The general was round the hospital again one morning last week, looking at the patients, but especially those who had been at the Front, with a kind word for each.

I only know one officer in just now, Lieutenant Welch, belong to the 19th Hussars, in with remittent fever.

We had our one little Easter Service this evening at 5:30, with Holy Communion. I am organist (but only a very poor one), so I had the privilege of playing the dear old Easter hymn,  ”Jesus Christ is risen today” to the tune “Worgan.” We decorated the church a little with palm branches and most exquisite sweet roses, light pink and light yellow. While thus occupied, my thoughts flew to dear old St Thomas’ and I wondered if Mrs Wardroper had decorated the Chapel there as beautifully as she used to in days gone by.

Yesterday was an oppressively hot day with a Khamsum and thermometer at 84 in a shady room. Today it is deliciously balmy and bright. Goodbye for the present.

yours very faithfully

Sybil Airy

 

Add Mss 45775 ff166-68, letter from Sybil Airy LM

Citadel Hospital

Cairo

17 November 1884

Dearest Miss Nightingale

The weeks and days fly by so quickly here that the homeward bound mail day is constantly finding me almost unprepared for it. Consequently (as now) I have to sit up late to write my letters! I received your kind card of October 24^th [missing], many thanks for it.

The three new sisters are a great help and comfort: Sister Barker, Sister Crump and Sister Ferguson are with us and Sister Hart is at Ramleh. Sister Barker and Crump each have charge of a Division and both seem very nice, and from what Sister Cannell says, they are very good workers. Sister Barker is rather pretty and is very sweet and gentle, both in manner and voice, and very lady-like. Everyone seems much taken with her. She looks pale and delicate, but appears to be quite well. I cannot fancy her standing the heat of this land, but that remains to be proved.

Sister Crump is a businesslike little thing and she throws her heart into her work. She was once at St Bartholomew’s and was devoted to Miss Machin.

Sister Ferguson is our night sister. Well what shall I say about her? I hardly know, for at present none of us take very kindly to her. She wants her own way too much. And she has no tact whatsoever. Nevertheless, it is very delightful having a night sister again! So I will try to say nothing more against her.

The hospital is in a very unsettled state in regard to doctors and orderlies–most of them are being changed every week or fortnight to “go to the Front,” which is somewhat trying.

I think we have about 300 patients, five smallpox patients are under canvas, two of these were sent down from my wards, having been admitted from the first as “Febricula.” But there are still some severe enterics in the Right Division and one in the Left. We have had several very bad dysentery cases chiefly from the Front, but are all improving, I am thankful to say.

We hear that General Wolseley[14] was so delighted with this hospital that he has given the order that  all dysentery cases up the Nile to be sent ‘here for treatment; he seems to have visited the hospital at Wady Halfa and to have told Sister Gray that “it was perfectly wonderful the improvement the sisters had wrought in this hospital.”

What would the doctors say to that! Sister Gray and Sister Clement, who are at Wady Halfa, both seem well, and tolerably busy; I believe they cook for the sick officers. They have about 60 patients I fancy, but I do not think the cases are so bas as those at Asouan [Aswan].

In a letter from Sister Yardley to Sister Cannell, the other day, she said that she and Sister King had got their hands full and each of them had got about 18 enterics to look after, 24 bad cases

And 12 mildish ones. She said [it] was rather disheartening for they were losing so many of the cases, and cases with no complications. But then, she said, they were constantly changing the orderlies of these cases; they seldom had the same one for three days running, they were always being sent up to the “Front” and others put in their stead. Without knowing that the orderlies were going to be changed, a sister would go to look after her cases again and find fresh orderlies and in one instance, Sister Yardley found a bad enteric sitting bolt upright in a chair, while the orderly, who thought he was doing a great kindness for his patient, was making his bed!

Some of my special M.S.C. orderlies I have caught letting my bad enterics sit bolt upright upon the bedpan, not knowing any other way for them to use it. And not long ago, I had trained orderlies put with these cases, who had not the slightest idea how to change a draw sheet, wash a patient’s back.

In that batch of orderlies there were some from all sorts of places, Dublin, Newcastle, Colchester, Ipswich, etc. But I think one of my very ignorant ones said he had come from Aldershot. All that rough set finally were sent up the Nile, alas! for their patients!

The doctors certainly are teaching the orderlies by the bedsides in their daily rounds, much more than they used to. So, on the whole, we must hope and trust that things are improving and I think they are a little.

Sister Cannell thought it so strange of Mrs Deeble that she never wrote and told her of these new sisters coming out. It seems she was not consulted about them. The girector-general took it

all into his own hands, had a list of sisters and selected them himself, being particular to choose those who had not been abroad before. Sister Barker also told us that not very long ago he had been down to Netley to see about the sisters’ food, of which there had been complaints.

This last week, we and all Cairo have been in a state of great anxiety for General Gordon and Khartoum, the daily uncontradicted rumour being that General Gordon was killed and Khartoum fallen. But on Saturday our minds were relieved by better news, I am thankful to say. But I fear poor Colonel Stewarts’ death is too true.

We are having such lovely cool weather here (in fact it is quite cold!) temperature in my room 65. I fear it must be very cold at home?

Mrs Fitz Fitzgerald has come out here again, as most likely you know. About a fortnight ago, she called upon us and twice since has been to visit our patients. I fear this is but a stupid letter, but I must end here, with love to all friends.

your very faithful servant

Sybil Airy

 

In a letter by Airy in 1885, she reported on an official letter she had received regarding the age limit to transfer to the permanent Nursing Service. She was over the limit, but was told the director-general would transfer her if she had a letter of personal recommendation from “a lady of position in society,” which she asked Nightingale to send. She enclosed an extract with her qualifications As well, she commented that people wondered when the war would end, living “for today, not knowing what the next will bring.” They were expecting four sick officers and 55 men from up the Nile. The doctors were giving the nurses one or two lectures a week. (Airy letter 28 April 1885, Add Mss 45775 f169).

Nightingale wrote a letter on Airy’s behalf with great commendation: she had been “sister” in an “important male surgical ward,” “always gave good, efficient service,” was “a first-rate nurse,” as well as being “high- minded, religious, true gentlewoman, unfailing in principle, in kindness, in discretion, in patience and perseverance.” The praise goes on, then a practical point made, that she be given credit for past service for purposes of pension (Nightingale letter 7 May 1885, Add Mss 45772 ff41-42).

 

Egyptian Campaign 1885

 

The 1885 Egyptian Campaign was ostensibly for the rescue of General Gordon in Khartoum, who in fact was killed  on 26 January 1885, the day before the rescuers arrived. No nurses were sent on that last part of the expedition, so that the correspondence following is from Cairo, Suakim and ships going back and forth to England. Disorganization would be a substantial theme in her correspondence to Nightingale.

Rachel Williams is the major source on the nursing in1885. She had not done any army nursing, but volunteer to go to Egypt when she about to be dismissed from the matron’s post at St Mary’s Hospital, Paddington, an unhappy subject related in Chapter xx. She made a triumphant start, cheered  by the medical students and patients as she left the hospital, in a fine new uniform.

 

Add Mss 4747 ff129-30, letter from Rachel Williams

[printed] St Mary’s Hospital

London, W.

21 February 1885

Isn’t it good of the authorities, they have nominated Miss Byam to go out with me as a sister. I can’t tell you how thankful I am for this kindness. She is, too, such a good creature and a magnificent worker. Dr Meadows this [illeg]was  a very kind letter he has had for Lord Carlngford expressing his pleasure on my accepting the post, adding “it is a very important one, also I am sure she will do great good.” May God help me to do “great good” expected of me.

Dear little sister[A.L. Pringle] is my one trouble, she is rather tender hearted at my departure, though very sweet and good about it all.

I have received as yet no marching orde . Miss Machen[15] is kindly leaving this note for me

always dearest Miss Nightingale

yours most devotedly

1. Williams

 

“Add Mss 47747 ff142-43, letter from Rachel Williams

23 April 1885

Dearest Miss Nightingale

I was telling Mr Verney last night of the amusing roughness of the medical officers mess table, a week I suppose is when he alluded to as the “small things” required, such as enameled tea cups and  saucers, tumblers, plates and dishes and  basics and  salt cellars and  mustard pots, mugs, etc., of different sizes, etc., a rather more generous allowance of knife fork and spoons! The soldiers in camp are each supplied with the one thing necessary, i.e., a knife doing duty for all things, etc. Many of the things I mention and others would be a positive blessing in the Base and Auxiliary Hospital. The necessaries that are very meagre, lunch and dinner.

 

Rachel Williams sent a letter to the editor to the Times, dated 5 April 1885, on the disorganization, including the lack of food and lack of equipment for patients. Williams made a point of praising the National Aid Society for supplying “extras.” It was a voluntary organization, forerunner to the British Red Cross.

 

Rachel Williams, letter to the editor, “The Princess of Wales’s Branch of the National Aid Society.” Times 6 May 1885, 10

 

Sir Having just returned from Egypt, with sick and wounded, I think I may be able to give you interesting information as to the work going on there. I am acting superintendent of nursing, with three nursing sisters under Government, in company with four others sent by the Princess of Wales’s Branch of the National Aid Society left England on the 4^th ult. [last month] for Suez.

On arriving there, however, they were all, with the exception of two of the latter sisters, who left us for Cairo, sent on at once to Suakim, help being needed there  in consequence of the fight at Hasheem and the attack on the zariba which had just taken place, and the expected attack on Tamai.

I must state in high terms of the arrangements we found there. In spite of the difficulties incidental to place and climate, the sick and wounded were well cared for, having good hospital accommodation, beds, sheets, pillows, garments, etc., and efficient and careful medical attendance.

The Government supplies are very good and are well supplemented by the National Aid Society, supporters will be glad to know that it is doing useful work out there, providing many very necessary and acceptable extras which otherwise could not be obtained.

Among other things I may mention a store in the sisters’ quarters which enabled them to add to the diet for the worst patients little delicacies which are much appreciated; Also the efforts which Mr Kennett Barrington[16] was making to provide fresh milk, so necessary for the sick. There was a plentiful supply of condensed milk, but that many were unable to take on account of its sweetness.

The boxes of medical comforts are well assorted; the cocoa and condensed milk are excellent; Ballatine’s meat juice we found especially useful for our patients on the homeward voyage; Brand’s essence would be a good thing to send out as, already having refrigerators there, it could be kept cool. This reminds me of the unlimited supply of ice from the hospital ship Bulima—a vast boon.

All the arrangements on the Ganges were excellent, and the food very good. On shore the meat and potatoes were, when we were there, very poor, and we often wished this could be remedied. We used to long for easy chairs for convalescents, also books and amusements. These needs, I hear, have since been remedied by the Princess of Wales’s Branch of the National Aid Society.

After remaining one week at Suakim, I and three sisters left on the 24^th of April with sick and wounded on the steamship Iberia, and with a quick passage arrived off Spithead early in the morning of 9^th inst. All the crew all helped in every possible way, and out of over 100 patients, the majority of whom were severe cases, four only succumbed during the voyage home.

I am. Sir, your obedient servant

Rachel Williams

 

Add Mss 47747 f146-4-47, letter from Rachel Williams

Suez Hotel Suez

18 May 1885

Dearest Miss Nightingale

We found when we reached Alexandria that we had just lost the mail, so that our letters written on board the Nengolia we have reopened and now will add some particulars of our curious experience here. But I must apologize for my curt telegram, which, as things turned out, ought not to have been sent [illegs]

We reached here on Thursday night at 7 p.m., but it was 9 p.m. before we came in sight of the hospital. The train had to go to the docks, where, after unloading, took us back as near the hospital as possible. This meant being put out in the desert half a mile from our quarters, bag and baggage surrounded by yelling Arabs, quite dark and not a reasonable soul about! At last I made them understand that we wanted to go to the English Hospital.

I therefore set off with one of the sisters to make known our approach and get help, leaving the other three sisters in charge of our belongings. [When we]  arrived in the hospital, we went to the sisters’ quarters such as would have been as assuring to put our heads into a lion’s den. The sister in charge (by name Selby) was that uncivil and inhospitable, would have nothing to do with us and would not allow us to stay there, even for the night, although it was close upon 10 p.m. In fact, so to speak, she turned us out and literally locked the door in our faces!

An orderly very kindly took me to the Sergeant Major who was politeness itself; he said no one knew of our arrival. It had not been notified from London, although’ there had been a deal of correspondence about the previous muddle of sending me and our party on to Suakim. We finally decided to leave two of our party at the hospital and I, taking another, accompanied by an interpreter and an orderly, started off to find Dr Davadge at the hotel, two miles off. We were famished and tired but happily overtook two donkies returning to Suez. On these we mounted [on] side saddle! And at 10:30 found ourselves at the hotel, much to Dr Davidge’s[17] astonishment, he not knowing of our coming any more than anyone else. He was very kind and arranged for us to remain at the hotel and sent word up to the hospital that the other two were to be housed there. This is the happy go lucky way in which the Medical Department appears to do its work.

The hospital was fully sistered (though I hear Sister Selby and crew are very satisfactory) and are a drag in the market! I, therefore, next morning telegraphed to you, but in the afternoon, after Dr Davidge’s visit at the hospital, the sister in charge sent in her resignation. I suppose she found her reception of us had been rather reprehensible. It is well known here that we are the people who ought to be in charge of the hospital. What we are waiting for now, I cannot make out, but Dr D. says her resignation has to go to Cairo, when accepted, but anybody else says he could take[us]  in quite well now install us, but he says he can’t, so here we are doing nothing.

Unless matters are settled soon, I shall request a passage home, and cut the connection altogether, or if they send me in a subordinate position elsewhere. Of course, in a day or two things may yet be arranged satisfactorily, in which case, I will let you know at the earliest opportunity, It is extremely bad luck–no doubt we should soon be happy enough, if we were settled, but to live in one’s trunk for more than 10 weeks is not very pleasant; we should, too, be very thankful for a little quiet.

The Tyne left this Sunday with a lot of invalids from Suakim and here in her voyage home. But nearly 200 more are coming from Suakim to this hospital. Several of the sisters have fallen ill at Suakim. Two are sent home invalided. Miss Rogers has left for home in the Geelong and Miss Machen left this morning for Cairo so that the Auxiliary has no sister. We here [hear] that Sisters Hicks and Downe [?] are going home too – nothing to do. So why send Sister Machen to Cairo? The ways of the Medical Department are inscrutable – Dr White was here when we came. He said Sister Hicks to be sure had had literally nothing to do.

always most devotedly yours

1. Williams

 

Add Mss 47747 ff153-54, letter from Rachel Williams hard to read, thin paper

Royal Victoria Hospital, Suez

11 July 1885

Dearest Miss Nightingale

I cannot tell you how grieved I am that you do you do even get my letters. I have written by every mail to you excepting the one when I asked Miss Pringle to let you know of our welfare, and on July 3 I telegraphed to you, a copy of which I send you. This I hoped would lessen your kind anxiety until you receive my letters. Of last mail, which now is possible you have not had, in the telegram I can’t in the least imagine, understand it, the mail is certainly very late but we are usually told when it comes and act accordingly. However, dear Miss Nightingale, please [illegs] do not be anxious about us now, for we are going to lose all our patients who can possibly travel, and if the men [illeg] all go, we shall only have some ‘30 or 40 less!!’

The Pervious Manalb is in the harbour. She takes several men home and on Monday the Bulimba from Suakim comes up and takes the remainder. I wish they would take us too! But at present I have heard of no “sisters” going with the sick (they could see the better officers!) There are doctors on board. At Suakim there is a fearful amount of sickness, we had to send 12 orderlies down there this week. I hear indirectly that Herman Bonham Carter is ill with enteric, but this I hope is not the case.

I shall go down and see the men in the Bulimba and perhaps may see Miss [illeg] on her way home. [illegs]

[I hear] that we are not likely to have many more serious cases here, all we have already had [illegs]. Suakim or the camp here The ill-fated Erin (who was on her way home from Suakim) when the block in the Canal occurred, brought us between 30 and 40 cases of enteric. You will, I hope, have received my letter telling you that the National Aid Society sent us [illegs], one in the place of the cookery sister and one to help us, but as things are now, and unless a huge convoy of men come from Suakim, we have ample help. The heat increases every day. One gets bathed in perspiration on the slightest effort. The very wind is hot.

We are all well, sleeping at night in the only dahabiah and then only Miss Wrigley and I are the sufferers. The others sleep like tops, partly the heat and partly the insects aid the general limpness of one’s body. Our Arab servant is a capital cook and caterer. We allow ourselves all necessary food and even some luxuries are [illeg] go as the others did in the saving principle. I do not think in such a climate it would assure as regards health–several of the orderlies have taken typhoid but that is [illegs]

I do not know who are leaving St Mary’s just now. Miss Vincent was one of our nurses, as a night sister. I think (Miss Wade) also [illeg] excellent assistant. Miss Dawson (the RC!!) would also be admirable in that position. She, I believe, is still at St Mary’s, but wanting to get away. With one or two exceptions the very last of the old staff have left. [illegs]

I am sending this off two days before the mail to ensure its being in time! Believe me dear Miss Nightingale

yours most devotedly

1. Williams

 

 

 

Add Mss45772 ff36-37, letter, from Dr T. Crawford

[embossed red crest] War Office

Weymouth

Sunday 29 November 1885

Dear Miss Nightingale

Your note of yesterday has been forwarded to me here and I hasten to reply. All the sisters sent to Suez have been summoned to Souakim, so that that there are 16 sisters there now, less probably than three or four on their way home with sick and wounded, but of this I am not certain. The Telegram merely assures me that an ample staff of medical officers and attendants accompanied the wounded on their way home.

I gave instructions before leaving town yesterday to send out four sisters to replace Miss Williams and her nurses at Suez. This we can do from our home establishment replacing those sent by new temporary appointments. If you have any eligible trained sisters on your list, I shall be glad to be favoured with their names. I have some matters to arrange at Netley which will delay me there tomorrow and Tuesday, but I hope to get back to town on Wednesday. I am here for the day only to see a relation who is dangerously ill and who was anxious to have my advice. On my return to Whitehall, you shall hear the latest particulars regarding wounded, nursing staff, etc.

Believe me, dear Miss Nightingale

very faithfully yours

1. Crawford

 

Add Mss45772 ff5-6 ff38-39, letter from T. Crawford

[embossed red crest] War Office

6 April 1885

Ansd. 16/4/85

Dear Miss Nightingale

I have been unavoidably absent from my office since the date of my last note, but this has not prevented my taking steps to provide for Suez. Nursing sisters will be appointed to that hospital by the PMO Egypt and his nursing staff will be reinforced from England, as already telegraphed to you.

We have no returns showing the actual distribution of the sisters sent out by your society, but I understood from Major Young that of the four sisters sent out two went to Suez and two to Cairo. The N.A. Society have not favoured me with any information regarding their ladies, but I believe the two sent to Suez have gone on to Souakim, where there is now an ample staff of sisters.

The two sisters sent to Cairo were destined by Major Young for Lord Wolseley’s force on the Nile but whether they have been sent there or not I cannot yet say, information on such points not reaching us by wire. Miss Williams and her assistants are also at Suakim, silence on the subject of their health may I hope be accepted as an assurance that all are well.

I thank you very much for your kind enquiries. The sick relation at Weymouth is better, but I returned home only to hear of the death of my wife’s brother, who was dangerously wounded at Suakim. Today’s telegrams report sick and wounded doing well.

very faithfully yours

1. Crawford

 

K.Philippa Hicks: Introduction

Katharine Philippa Hicks recounted, years later, preparation for the Egyptian campaign of 1885. She was a “Nightingale nurse,” who had begun her training in 1881 and kept in touch with Nightingale over the years since then. The two bonded, such that Hicks was invited to Nightingale’s home to talk, even to breakfast before departure for Egypt, and to use her house in South Street on her return when Nightingale was away.

 

Philippa Hicks excerpt from Cook, The Life of Florence Nightingale, 2:347-48

 

The rapidity of Miss Nightingale’s decision, her memory for matters of detail, thoughtfulness for others, even in trivial things, her kindliness of heart  interlacing the practical instinct, the mingled playfulness and gravity of her manner—these things are all illustrated in the reminiscences of another member of the party which sailed for Egypt in the Navarino: “I was then Sister of one of the surgical wards at King’s College Hospital. It was on a Saturday in February, about mid-day, just as I was due to attend the operation cases from my ward, that a one-armed commissionaire appeared at the ward door: ‘A note for Sister Philippa from Miss Nightingale,’ he said. The request it contained was characteristic of the writer—decisive, yet kindly. Would I leave in three days’ time for service in the Sudan? If so, I must be at her house for instructions on Monday at 8:30 a.m., at Marlborough House to be interviewed by Queen Alexandra (then Princess of Wales) at 11 a.m.; and immediately afterwards at Messrs Cappers, Grace Church Street, to be fitted for my war uniform. Would I also breakfast with her on Wednesday, so that she “might check the fit of my uniform, and wish me Godspeed.”

 

Hicks went on to describe reminiscing with Nightingale over that three days’ rush to prepare for the Egypt trip:

 

Philippa Hicks excerpt in Cook 2:348

 

Again and again she would refer to that afternoon when I had to stand by the patient’s side in the operating theatre, mechanically waiting on the surgeons, outwardly placid, yet inwardly, as I told her, in a fever of excitement, not so much at the thought of going to the front, as at the fact I had been chosen by her to follow in her footsteps.

On the Monday above referred to, punctually at 8:30, I arrived at South Street, wondering what my reception would be, but before ten minutes had passed all wonder and speculation had given place to unbounded admiration and (even at the early acquaintanceship) affection for the warm-hearted old lady who counselled me as a nurse, mothered me as an output from her Home, and urged me to spare no points—myself specially—where the soldiers were concerned. “Remember,” she said, “when you are far away up-country, possibly the only Englishwoman there, that those men will note and remember your every action, not only as a nurse, but as a woman; your life to them will be as the rings a pebble makes when thrown into a pond—reaching far, reaching wide—each ripple gone beyond your grasp, yet remembered almost with exaggeration by those soldiers lying helpless in their sickness. See that your every word and act is worthy of your profession and your womanhood.

 

Hicks then described Nightingale’s parting gift to her, an india-rubber travelling bath, recalling that she, as a probationer, had reminded her that “cleanliness was next to Godliness.”

There were “ tears of anxious kindness as she added, “God guard you in His safekeeping and make you worthy of His trust—our soldiers.” 348-49.

 

Philippa Hicks excerpt, from Cook 2:349

 

I saw nothing more of her till Wednesday morning . The troop ship in which we were to go out left Tilbury Docks at 11 o’clock, and I was to breakfast with Miss Nightingale at 7:30. It was rather a rush to manage it, but it was well worth any amount of inconvenience to have that last hour with her, and it was a picture that will always remain above all others in my memory. Propped up in bed, the pillows framing her kindly face with a lace-covered silvery hair, and twinkling eyes, I often think her sense of humour must have been as strong a bond between her and the soldiers as her sympathy was. The coffee, toast, eggs and honey “a real English breakfast, dear child,” she said, “and it is good to know you will have honestly earned the next one you eat in England.” “And suppose I don’t return to eat one at all?” I asked. “Well! You will have earned that, too, dear heart,” she answered quietly. Who can be surprised that we worship our Chief? Other nurses were going out in the same ship as I, and when we entered our cabins, we found a bouquet of flowers for each of use, attached to which was “Godspeed from Florence Nightingale.”

 

Hicks’s reminiscences continued six months later, and show Nightingale’s concern for the recovery of a returning nurse after war service. Nightingale invited her to stay at her home in London while she was at Claydon House, in Buckinghamshire, and then also invited Hicks to join her there for a visit.

 

Philippa Hicks excerpt, from Cook 2:349

 

Six months after in the glare and heat of an August afternoon, when the Egyptian campaign was a thing of the past, a shipload of sick and wounded soldiers glided slowly into the docks at Southampton. While I was helping to transfer some of the most serious cases to Netley, a telegram was handed to me. It was from Miss Nightingale: “am staying at Claydon, cleaners and painters in possession of 10 South Street, but two rooms, Mrs Neild[ the housekeeper] and a warm welcome are awaiting your arrival there. Use them as long as you wish.” On arriving at South Street, I found it all just as she had said, and by the first post next day came a letter from Claydon, such a home welcome! It was well worth all the heat and glare of a Sudan summer, all the absence of water, and presence of insects, and the hundred and one other uncomfortable things that flesh is heir to during similar circumstances, to get such a letter of welcome as that. It ended up with “make South Street your headquarters till your work is finished” (there was much detail to complete in connection with the National Aid Society before I could leave London), “and then come to me at Claydon.”

So,  after a couple of weeks’ work in London, I went to Claydon, and there, during a month’s rest in one of the most beautiful of England’s country homes, I learned to know and understand Miss Nightingale, who realized what the friendship of a character like hers means. “The essence of Friendship,” says Emerson, “is tenderness and trust.”[18] No words better describe our Chief than these.

 

Further remarks from Philippa Hicks appear in the last section of this book, on her reminiscences of Nightingale after her death.

 

Add Mss 45808 ff18-19, letter from Surgeon-General Arthur Payne

57 Caulfield Gardens

14 January 1888

My dear Madam

Now that the work of forming a staff of nurses is completed, you will probably be interested in the result. Two ladies already working in India had been appointed as sisters. The superintendents are Miss Loch of St Bartholomew’s and Miss Oxley of Guy’s. The sisters are: Miss Belty, Miss Welchurch, Lickfolds, Kelly, Harris, Hill, St Bart’s; Miss White, Guy’s; Airy, Egypt; Miller, Guards Hospital; Beresford, Birmingham.

Miss Airy sent me your letter too late for presentation. Her name was received however without a word of dissent. It remains only for the Secretary of State to pass final orders on the resolution of the committee. I was glad to receive your letter as it implied absolution for I had mentioned your hand in bringing her forwards, again ]illeg] my character with you. I have to the utmost carried out the original design of getting the best superintendents I could find and leaving the choice of subordinates with them, subject only to the statutory conditions of service. The staff could not be entirely formed from ladies who had served with the superintendents and I thought it would be well to introduce a little army experience. It seems that Miss Airy visited Miss Oxley by whom her name was presented to me with enthusiastic words–Miss Airy and Miss Miller represent the army, Miss Beresford is good all round and has special experience of eye practice, which will be useful. I hope the result will so far be satisfactory to you. I cannot thank you adequately for all the support and encouragement your various and cordial interests have afforded her.

yours very truly

Arthur Payne

In 1887,returning, again, from Cairo, Airy was rescued from the wreck of the Tasmania and returned safely to England (Nightingale letter 25 April 1887, Ms 9011/123).She gave an account of the rescue, in Corsica, to Nightingale, which she passed on to Sir Harry Verney, who had invited Airy to stay at Claydon House to recover:

Her account of the rescue, of the hospitality of the poor Corsicans, was the most touching, the most simple and lovely, in the midst of overwhelming seas and  the thunder of waves and wind, with the soft spring wild flowers where they landed, and the glorious scenery of the snowy mountains of Corsica down to the very cliff under which they struggled ashore when their boat was swamped and their final conveyance in about 30 carts, 2 days after to the fashionable chef-lieu of Sartene, a town clinging to the sides and top of a rock like the Peak of  Teneriffe, surrounded by similar peaks covered with snow–and all for others and  nothing for herself . She seemed lost, in helping the ship-wrecked, and children .I must write you the whole account (letter 12 May 1887, Ms 9011/131 [1:380-81]).

Nightingale told Anglican nun Sister Frances that Airy had reported herself  “scarcely at all afraid” and, thought her sisters “ were singing ‘Eternal Father, strong to save’  for her–quite cheery” (letter 28 April 1887, LMA HI/ST/NC1/87/18/1 [3:219]).

In 1889, when Airy was appointed lady superintendent at the Royal Victoria Hospital, Bournemouth, 25 beds, Nightingale reported this to fellow sister Miss Winterton: “she wished for it very much” (letter 17 July 1889, Add Mss 45809 f170, in 13:213-14].

 

Other nurses in Egypt

 

Add Mss 45808 f92-95, letter from Charlotte illeg [?]

Kaisr el Aini Hospital, Cairo

4 April 1888

Dear Miss Nightingale

No doubt you have heard from Miss Pringle of our safe arrival. I had hoped to write you last mail but our time is very fully occupied, and I feel rather dazed and still among the strange faces, picturesque costumes and unEnglishy ways.

You will be glad to know we have received every kindness and consideration from Dr Milton, Dr [illeg Rauchwich?] who is now on the committee and also from several English [illeg]. Sir Evelyn Baring too has been most kind. He inspected the hospital the other day and was introduced to us and he has kindly placed his carriage at our disposal till October, when Lady Baring returns. We have also made the acquaintance of the English clergyman, Dean Butcher.

This is a large hospital, 350 beds, and Dr Milton has [illeg] for it. The hareem [illegs] only contains 100 beds. I like the patients very much. They are very childlike and friendly but it pains me much not to be able to understand them. The nurses also are being friendly, but I don’t expect they like our coming. It is wonderful how smart they are in some ways, for instance, at operations they might be the envy of many English nurses, as Dr Milton has developed them so much. I hope in time we may get across instruction in cleanliness and the cleaning of laundry. No progress can be made till we can talk to them.

We began Arabic last week and have a lesson daily. I understand there is some examination to pass at the end of six months, which sounds alarming.

At present, we get very little time to study, but by and bye we are able to plan our work better and feel the heat less. I hope we shall make some signal progress.

I enjoyed the voyage. After the first few days and our pass as Gibraltar and Naples were charming. I have also seen the Pyramids by moonlight and was much impressed with the grandeur of the scene.

I hope you are better than when we left, and able to get out. Miss [illeg] smiles with me.

with all good wishes I am, dear Miss Nightingale

yours affectionately

Charlotte [illeg]

 

Helen Norman: Introduction

 

Helen Campbell Norman (1856-1813) was the daughter of Field Marshall Sir Henry Norman. She trained at St Mary’s, Paddington, under Rachel Williams and went to the Suez in 1882,making her  the first British nurse there. She was awarded the Royal Red Cross in 1883, in the first group, with Nightingale. She later followed Deeble as superintendent of nursing at Netley Hospital, serving 1889-1902. She became matron-in chief at the Queen Alexandra’s Imperial Military Nursing Service when it was constituted. 1906-10).

The arrangements in Suez when Norman arrived were, as Nightingale reported  to Sir Harry Verney, “ sadly unsatisfactory as far as nurses are concerned “(letter 11 September 1882, 9009/88 [13:2070]. When back in England in 1883, Norman told Nightingale that they were “nobody’s children. The medical officers don’t stand up for us. The military look down on us .Nobody looks after us.” She commended one Netley orderly. Dr Longmore’s assistant was the only man who took any interest in his cases (Nightingale note 19 November 1883, Add Mss 47763 f139). There is no correspondence from her.

Nightingale was updated on Norman’s career moves. In 1891, she was told of her first tour of inspection as lady superintendent at Netley (Snodgrass letter to Crossland 13 March 1891, Add Mss 45810 f188).

 

Letters from Dr F.M. Sandwith

 

Fleming Mant Sandwith (1853-1918), physician at the Kaisr-el Aini Hospital, was the author of The Medical Diseases of Egypt. His first letter below carries on from an earlier correspondence, here to relate the death of Amy Hughes.The  second letter from him below , from the Women’s Hospital in Cairo raised the prevention of infantile blindness, a matter Nightingale pursued with a later correspondent in England.

 

Add Mss 45809 ff208-09, letter from Dr F.M. Sandwith [black-edged]

Cherry Burton Rectory

Hull

30 August 1889

 

Dear Miss Nightingale

So many thanks for the two primers which have which have just been forwarded to me here and which I shall study with the greatest pleasure.

I have just heard of poor Miss Hughes having typhoid in Cairo and also, in a roundabout way, the dreadful news of her death. If this is true, it will be a terrible blow to us all and to the Cairo Nursing Fund.

We must try and build quarters for the nurses apart from the hospital.

With again many thanks

F.M. Sandwith

 

Add Mss 45809 ff210-11, undated letter from F.M. Sandwith [get salutation, date?]

New Women’s Hospital

Kasr el Aini

Cairo

[ca. 1889]

The new Women’s hospital, nursed for first time by Mahomedan women, chiefly girls from school from 15 to 20, under an English trained lady superintendent and trained lady nurse and 3three other lady nurses, who vibrate between private nursing in Cairo and the hospital. About 130 beds are for women and children, besides very large Out-Patients’ Department for women and children, like the hospital the first of its kind.

Of course chief thing is to inculcate cleanliness. Mahomedan infants (but Coptic Christian infants are worse) generally have ophthalmia the first week. (The mothers take no pains to prevent flies settling on the ophthalmic eyes. The children are never washed. The mothers generally go out same day as their lying-in, and even after craniectomy, they will be out on the second or 3rd day); In the case of the ophthalmic children, they are generally not brought to the Outpatients’ department or to any doctor till too late. If they don’t come in the first week, they are generally stone blind for life with those terrible white eyes.

But now we insist upon their coming before it is too late, and we pay the greatest attention to teaching them sanitary habits. Now when a poor infant is brought stone blind for advice we hold it up to the other mothers and we say, “Now look here, you’ve brought your children in time and you’ve kept them clean as we order, and their sight will be saved if it please Inshllah” ]God willing]. And then, with a majestic manner, we order the mother of the blind infant out of the place. (It sounds cruel, but nothing could be done for the blind child) and then we hear a murmur of self-complacent pride running in Arabic through all the mothers who have done what they were bid, pointing like Pharisees at the poor women who are sent away and murmuring “stand aside, we are better than thou.” This is very salutary.

But the important part is the effect upon marriage among the Mahomedans of these Mahomedan nurses. It is the first time that women have been employed, that there has been a career for unmarried women. These women (who come to hospital as nurses at 15) have been very far better educated than any of the men of their class. The women are always sharper than the men. The hareem has always the whip hand of the gentleman and now we find that these women don’t choose to marry inferior men and men are afraid of them and won’t marry them, and that it appears likely to begin quite a revolution in Mahomedan ideas.

Will this not make great difference in lives and ideas of marriage of Hindoo women (see Lady Dufferin’s work). There has only been 1 marriage among the Mahomedan nurses and that according to our English principals a scandal. We had a patient–an elderly woman with incurable ovarian disease. No man of course enters any of the wards or sees any of the women patients excepting the men doctors who don’t count. No visiting even of husbands is allowed, but the doctor touched with compassion unhappily once allowed the husband of this poor incurable woman to come see her. Most unluckily a beautiful girl of 14 had presented herself as probationer and at that moment we sent her into the ward to see what it was like. The husband saw her for a minute and married her (outside the hospital of course) and took her home and divorced the wife. After a time we could not keep her because she was incurable and we have no right to spend the hospital funds upon such cases. But the nurses though they have only a pound or two a month wages actually clubbed together and paid for the poor woman’s food and so ended this curious case.

Sanitary state of Cairo very bad indeed. Typhoid very prevalent in European quarter. Alexandria Port not worse than other Eastern ports. Baldwin Latham has been sent for to report difficulty then how to raise the money, but they are thoroughly in earnest about it with Sir E Baring at their head. Difficulty consists in these different consular jurisdictions (Capitulations). This difficulty will be extreme because every consul is sort of governor or autocrat over each nationality and each nationality’s interests and even dwellings. Dreadful capitulation, but they are so much in earnest and the life and death question is so urgent and Sir E. Baring so powerful that if the French can be got over I suppose we shall have it our own way.

Memo to find out what Paris Conference did exactly say.

It is said that the Times is wrong on its paragraph, as it always is.

I was consulted by a lady who wanted to bathe in the sea and I was able to point out to her exactly the places which were quite safe. The mischief of the sewage being discharged into the port is not greater than it is in many places in Europe, nothing to compare in danger with Port of Bombay and it might be remedied by carrying culverts out to sea beyond Port.

 

 

 

 

 

[1] Vincent de Paule (1581-1660), founder of the “Daughters of Charity,” commonly called the “Sisters of Charity.”

[2] Jessie Lennox herself became the pioneer matron at the Belfast Children’s Hospital.

[3] A pupil from the (charitable) Blue Coat School.

[4] Alice Mochler, former governess to the children of Nightingale’s favourite cousin, William Shore Smith; Mochler also gave assistance to Mrs Nightingale.

[5] W.A. MacKinnon (1830-97), assistant professor of surgery at Netley, later director-general of the Army Medical Department.

[6] Thomas Crawford (1824-95), director-general of the Army Medical Department  1882-96), later a member of the Nightingale Fund Council

[7] Anne Ellen Caulfeild (ca. 1845-1937), awarded the Royal Red Cross, the  Egyptian Medal and bronze star for her heroic work in Egypt.

[8] Elizabeth Wheldon (ca.  1826-?),  assistant matron at Netley, recipient of the Royal Red Cross in 1883.

[9] Curzon Drury Lowe (1830-1908), knighted in 1882, commander of the Cavalry Brigade.

[10] Sir Leicester Smyth (1829-91), a former aide to Lord Raglan during the Crimean War, later commander in the Cape and High Commissioner to South Africa.

[11] Thomas Crawford (1824-95), KCB, director-general of the Army Medical Department. On his retirement, he accepted Nightingale’s invitation to become a member of the Nightingale Fund Council

[12] Thomas Dyke Acland (1842-1919), son of Nightingale’s friend Sir Henry Acland, Regius professor of medicine at Oxford.

[13] Probably the 36-page Gordon: A Life of Faith and Duty by W.P.G., published by the SPCK ,1885.

[14] Garnet Wolseley (1833-1913), commander-in-chief in Egypt.

[15] Mary Machen, a nurse at St Mary’s, not to be confused with Maria Machin.

[16] Vincent Hunter Kennett-Barrington (1844-1903), later Sir, commissioner for the National Aid Society.

[17] John Davidge (1831-1917),  surgeon.

[18] Ralph Waldo Emerson, from his pamphlet Friendship.