Once a Week (magazine)/Series 1/Volume 9/Florence Nightingale's latest charity
FLORENCE NIGHTINGALE'S LATEST CHARITY.
The story of the appointment of a Sanitary Commission, to inquire into the facts of the health of our army in India has been told so often, within a few weeks, in parliament and through the press, that I need not repeat it here. Suffice it that till now there has been a sacrifice of life and health in India which nobody seems to have thought of controlling by any system of management, founded on clear principles, and conducted by qualified persons. The inquiring Commissioners have now satisfied themselves, and everybody who reads the evidence they have presented, that the great mortality which has been supposed to belong to India is no more necessary in India than anywhere else; and that people would die off anywhere in the world as they die off in India, if they were exposed to the same dangers. It is now settled beyond dispute that it is not the heat of India which makes our soldiers, and their wives and children, and the civilians from this country, and the natives themselves, sicken and die. It is now proved that the heat, of itself, offers no obstacle to man or woman of any race living to a good old age, and dying easily and quietly at last, in the very hottest part of the interior of India. It is only when combined with other influences that heat is perilous and fatal; and the two other conditions which, in conjunction with heat, create the tremendous mortality of India, are actually within our own power. The peculiar mortality, then, is needless: the health of our troops, and of our fellow-citizens there, English and native, is in our own power; and we from this moment, become answerable for all destruction of life and health in India which may be prevented by means clearly pointed out to us.
The two incidents which, together with heat, create the diseases which sweep away the majority of victims are—moisture, and decaying vegetation. The heat we cannot help. The other two mischiefs we can control: but it must be done in a comprehensive and systematic way. A bit of drainage here, and a bit of sweeping there, in such stations as happen to be blessed with a wise commanding-officer, will not extinguish the four great diseases,—the fevers, the dysentery, the liver complaints, and the cholera,—which among them make up the far-famed mortality of India. The Commissioners therefore recommend that a new Department of Government shall be set up, charged with the care of the health of the community, military and civil, native and European. We have now—thanks to Sidney Herbert—such a department organised for the preservation of our army at home and in the colonies. The proposal now is that two members of the Indian Council in England shall join the Home Commission, in order to learn all that is known, and see what can be done for the preservation of health on a large scale: and that each of the three Indian Presidencies shall have a Commission, consisting of members duly qualified to see to the drainage of the soil, the supply of pure water, the healthiness of the military stations, and of the construction of barracks and camps, the cleansing and paving of the towns, the institution of proper hospitals, and the provision of such occupations and amusements for the soldiers as may promote vigour of body and mind.
After getting together all the evidence they could think of or desire, the investigating Commissioners put it into the hands of Miss Nightingale, to whom the institution of the whole inquiry is in great measure due—requesting her to comment on it for their guidance. They wisely and fortunately chose to print her commentary with their Report. It is to be hoped that it will also be published separately, that it may convey some very important knowledge to thousands of persons who never dream of sitting down to the study of an enormous Blue-book like the one before me. Meantime I am strongly tempted to place before the readers of Once a Week some of the features of life in India which Miss Nightingale presents with singular vividness. Feeble as her health is unhappily known to be, her views have lost none of their distinctness—her pen none of its power. In this commentary we find in perfection the consummate good-sense, the keen irony, indicating subdued sensibility, the wide range of understanding, and the all-pervading generosity and courage which, to my mind, make her writings one of the strong interests of our time. From the few pages of this commentary we learn more of the interior of life in India than a dozen books on India from the circulating library could convey; and we see in a wholly new light, as clear as the day, how much may be done for the life of everybody there by such means as are perfectly at our command.
During the mutiny, the common practice of thrusting our soldiers' wives and children into barracks, without much consideration of their numbers, was followed at Dumdum (in Bengal, not very far from Calcutta). There were 554 women, and 770 children. There they were to live and take care of themselves, while their husbands and fathers were fighting the rebels. They were uncomfortable; they had nothing to do; they were in a strange land, among strange customs, which perplexed their notions of right and wrong. The weak went astray in drink and other indulgences; they lived in dirt, dullness, and depression. Presently 64 of the wives and 166 of the children were dead of dysentery: and the mortality in those barracks was six times greater than that of Bengal generally, unhealthy as Bengal is reputed to be. Far west, at the same time, there was another assemblage of soldiers' wives and children,—those of native soldiers under the rule of Sir John Lawrence. It was at the time of the siege of Delhi: and the native officers looked to see whether their wives and children were cared for. Sir J. Lawrence has views on this subject; and now the value of them has been proved, he thinks that a married officer should remain to take care of the women and children who are left behind,—to help them to communicate with their husbands, to see that they get their remittances,—to be, in short, a friend to them. This sort of care was taken of the wives of the Delhi soldiers; and they prospered. The story of how the widows of brave men were cared for spread among the natives. "The men all heard of it," says Sir John Lawrence, "and felt it very much." Miss Nightingale remarks that more of our own people died in the Dumdum way than by other sorts of "massacre"; and that while our soldiers were pursuing the murderers of English women and children, their own wives and children were being killed off by means for which no native was answerable.
But the wives who go to India are far fewer than those who are left behind. This opens a chapter of horrors upon which I will not enter. The perils and troubles of the forsaken wives are shocking enough: but our business here is with those who are in India. The husbands consider it a divorce, and are among the worst men in the regiment, as those who are allowed to take their wives are usually the best. The wives are in the greatest danger,—through bad arrangements. They are a mere sprinkling of women in a crowd of men; and, when one is left a widow, she must marry within six months, or be turned adrift. Sir J. Lawrence says this causes the utter ruin of many "a decent body" who "must marry the first that offers, or do worse." Such management accounts for much of the intemperance and dissipation which produce liver-complaints in the soldiers, and break down their health and their self-respect together.
The contrast presented to us is remarkable. At some stations, the married soldiers are living in bamboo huts, airy and quiet. They have home interests; and during their leisure hours, they are incited to employ themselves. They not only take their little children on their knees, but provide many a good thing for them by handiwork. Meantime, the divorced men are drinking, or gaming, or asleep, or in hospital; and in any case preparing their constitutions to give way under the first attack of disease.
Here is a view of the soldier's day in ordinary Indian barracks or camp;—the soldier, that is, who has no wife and children, and therefore no claim for domestic privacy, and no trade to pursue, no occupation, no amusement provided for his use.
A barrack-room may contain from 100 to 600 men, who usually have to pass twenty out of the twenty-four hours there. All they can do, except when at drill, is to eat and drink and sleep. They do not even cook their own meals, but doze on their beds while native servants are doing it. They rise at daybreak, and are at drill for an hour. Then they have breakfast, and lie down on their beds. The rest of the day is, "dinner, bed: tea, bed: drink, and bed for the night." Amidst all this idleness and all this heat they eat meat three times a day, in all seasons. They get nothing before they go forth into the early morning fogs; and then have three heavy meals in the hot hours of the day. They have no fortifying cup of hot coffee before morning drill; but they have two drams of spirits and one of porter when they wake up to eat their heavy meals. "Alcohol and unrefreshing day-sleeps" are pronounced fatal to bodily and mental vigour; and there is markedly better health among the men when on long, hot, laborious marches, or when engaged in the toils of a campaign, than in the ordinary course of life in barracks. Miss Nightingale comments thus on the system:
"Suppose any one wanted to try the effect of full diet, tippling, and want of exercise, in a hot climate, on the health of men in the prime of life, the Indian army method would be the process to adopt, in the certain expectation that every man exposed to it will be damaged in health.
"While all this scientific 'turkey stuffing' is practised, the men are carefully kept in barracks, and not allowed to exercise themselves. And everybody seems to believe that the way of making diseased livers in geese for Strasburg pies is the best way of keeping men's livers sound, and of making efficient, healthy soldiers for India. Wherever the régime is otherwise, as in the case of cavalry and artillery, who have some exercise, or where an enlightened officer allows his men to go shooting, there is, of course, improved health. But nobody learns the lesson.
"People seem to consider that health is a natural production of India, instead of being the result of rational management. At the same time everybody says that India is 'so unhealthy.'"
In contrast with this dreary picture, again, there may be seen one at Sealkote, another at Rangoon, and a few more here and there which to read of is like meeting with a spring in the desert. There the soldiers find themselves safer and happier under the hottest sunshine in the open air than snoozing in a crowded room, in the intervals between drams. But for the hottest hours there is a shaded reading-room, with sixteen newspapers, books, chess-boards and other games. As soon as the sun declines, however, the men sally forth to something they care for more. Some go to work at their respective shops,—the tailors, the armourers, the shoemakers, the saddlers, and the watchmakers. Others repair to their garden, where they are raising vegetables for sale, or for prizes. Tools, seed, and land are provided; and, where there are hours cool enough for cricket, there are some which admit of gardening. One regiment there has 8000l. in its Savings Bank; and at that station nobody seems to find it too hot; and we hear no complaints about health. What we do hear is that more workshops for other trades are desired, and also a gymnasium.
In this department of health,—this creation or preclusion of liver-complaints, the errors are of a kind which only a central authority can get rid of, and the advantages are such as only a central authority can diffuse throughout India. The issue of spirits must be stopped altogether as a daily custom, and pure water, coffee, beer, and any innocent drinks substituted, and made obtainable at the canteens. The canteen system must be reformed; and if the poison of native spirits cannot be wholly put out of reach, every inducement should tend, not as now, to encourage tippling, but to occupy the men's thoughts, and gratify their taste with something better.
Again, in the erection or improvement of all Stations, provision must be made by adequate authority for industrial pursuits and harmless amusements being always open to the men. A sharp line of demarcation might easily be drawn between the men whose minds are interested, and fortunes improved by profitable labour when off duty, and the wretches who sink under the curse of ennui, and the temptations it brings with it. At one station there were thirty-six cases of delirium tremens in one year (1859), while at another there were more than thirty-six good fellows, well and cheerful, laying by earnings in the Savings Bank. From one regiment there may be deserters by the dozen,—miserable men who find their days intolerable, and "see no prospect," after having known formerly what it was to earn money at a trade: and, in contrast with those, there are elsewhere men entering into competitive examination within their own regiment, of whom twenty are declared qualified "for the administrative service of the Government in the civil and military departments."
On the one hand we see desertion, corruption, suicide, or a slower death in hospital or by invaliding. On the other we see men striving to become good soldiers first, in order to get leave to follow their trades, or enter into competitions afterwards, under every inducement to preserve their respectability, and thereby under the best conditions in regard to health.
The general conditions of health are altogether unattainable except through such a central authority as it is now sought to establish. "Moisture is everywhere," as the evidence tells us. Where it does not appear on the surface, it has merely sunk into the subsoil, to reek up into the dwellings and the outer air, mixed with vegetable refuse, and thus, in combination with heat, completing the apparatus for the generation of fever, dysentery, and cholera. Every kind of liquid is thrown out upon the ground,—the emptyings of kitchens, and chambers, and baths, and washtubs; and it must evaporate either there or from the subsoil. It makes noisome fogs in the early mornings, in which the soldiers awake gasping and choking,—it being the practice in too many barracks to make the ground-floor rooms the dormitories. At mid-day, the stench reeks up under the sun; and at sunset the mists gather again round the sickening soldiery, who dread the sufferings of the night. If openings to the outer air exist, the men close them, to stop out the smell; and by morning they are sick with the foulness of their close rooms. When they can, they spread their beds in verandahs,—the only effect of which is to expose them to the foul damps, while to those within the air comes laden with the breath and moisture from the bodies of the outer rows of sleepers. Nothing effectual can be done for our troops in India till a thorough drainage has been established for a considerable distance round their stations; and this can be done only by a well-qualified central authority. The wisest commanding officers can only employ native scavengers to remove whatever can be carried away; and some admirable illustrations in Miss Nightingale's document show how this is done. Two men carry an open tub on a pole between them; or a woman marches from the barracks to the river, or the nearest tank, with a vase on her head, containing as much as she can carry. Under such circumstances, it is only the lowest refuse that is removed; and the water from wash-basins and tubs is poured out on the ground under the windows. If there are drains anywhere near, they are sure to be choked; and if there is a tank, it is used as a sink. When water is wanted during the day, the native servants go for it to the tank,—skimming away the weeds or the floating oil from the surface, and dipping for the water which is to clean the floors, or boil the vegetables for dinner.
This brings us to the topic of Water Supply.
Water must be got from one of three sources;—the tank, or a well, or a river. The tank can seldom or never be guarded from native access; and when it is so guarded, the water corrupts from being stagnant. What happens when open to the natives, I really cannot describe. While the subsoil remains undrained, the wells must be foul from what dribbles into them, even when, as rarely happens, no dead creatures are thrown in from above. The river is considered the best resource of the three; and in remote country places, where it runs unobstructed, and well guarded from pollution, the water may be good: but such cases are rare. In populous places, we know how the Hindoos use their streams; and we cannot wonder if the soldiers themselves cannot resist the temptation to bathe.
Such water as there may be at any station is supplied by water carriers. Nothing in Miss Nightingale's commentary is more striking than the cut which represents "Water Supply" for a country inhabited by 150,000,000 of our fellow-subjects, besides our own soldiery, civilians, and settlers. Water supply and cleansing are represented by two personages, the bheestie and the mehter. The former carries a skin of water over his shoulder; and the other bears a little broom in his hand, and a basket under his arm, while two vases stand at his feet.
Where such is the supply, the soldiers cannot or do not take care of their skins. If there is some little provision of baths, it is seldom that water can be spared for them. At some stations the lavatory is a room—generally the darkest and dampest—where iron basins are ranged on a stone shelf, where the men are tempted to be satisfied with washing face and hands till they can get a chance for a bathe. Yet there is plenty of pure water to be had if the means of getting it were provided. The Himalayas bear snows enough; the other mountain ranges send down streams enough; the rocks afford springs enough, to quench the thirst and cleanse the abodes of all India. But how can the wisest commanding officer give his men the benefit of it? He can only filter and ice the water that happens to be within his reach; and filtering and iceing do not get rid of the worst impurities of foul water. It requires the authority and the means of a Presidential Department to create channels for the pure water, and to guard them from pollution; and, till this is done, our soldiers will be more or less dirty in their persons and their barracks. Till drinking-fountains are provided at all stations they will be intemperate. Till this is done, in short, on a complete scale, till there is no longer unwholesome moisture in the soil, and plenty of the pure fluid in proper channels, our soldiers, who have cost the country 100l. each when they arrive in India, will be swept off by cholera, fever, and dysentery, in the vigour of their years. When this indispensable work is done, the next generation will scarcely believe that their fathers went on, year after year, raising fresh recruits by thousands, and burying most of them before they had well learned their business, so that the veteran soldiers in India of ten years' standing amounted to less than a fourth of the force stationed there.
It requires a Council of Health officers, Military officers, and Engineers, to determine the proper situation for new stations, barracks, or camp. A seaside station sounds well; but Sir C. Trevelyan found an astounding mortality in one which was boasted of for its site. The sea-breeze was shut out, and the air within kept stagnant by a high wall without a break. He had the wall lowered six feet, and pierced with windows and a door, and the extra disease and death disappeared. Military authority may point to an upland high above the sea level, and ask what better site could be proposed; and the Health officer will reply that he must examine the spot before he can reply. He finds that the barracks are to be built in a slight hollow in the table-land, just depressed enough to receive the downflow of the neighbourhood, as in a basin. The case is not so bad as it was, the worst barracks being "burnt in the mutiny," and some regard being paid to the advantage of high ground in the planning of new ones; but the thing can never be done wisely and well by military officers who select the ground for military reasons; or by civilian officials ignorant of sanitary science, any more than by sanitary officers ignorant of military requirements, and unaided by engineering advice. It needs a Commission in each Presidency, combining these elements, to place our troops where they may have a fair chance for their lives.
The same considerations apply to the case of Hospitals, which are at present "mere makeshifts." It is heart-breaking to read of hospitals where men go, not to revive and recover, but to suffer and die, for want of precisely what a hospital should supply. "Means of washing—two earthenware pie-dishes," or "one basin to 100 men," on a form in a stinking room, "very chilly in damp weather;" "surgeons' and nurses' quarters a mile off, so that they spend their whole day in going backwards and forwards on the road." Here a wall all round, so high that the place is stifling; and there the walls so damp that charcoal has to be burnt in the wards. Salt is burnt also, in corners whence an intolerable stench otherwise issues. Patients, whether they can or cannot sit up, have their meals served on their knees for a table, or go without. Convalescents from dysentery can only lie on their beds in a ward full of sick or dying patients in the same disease, till they are reported able to go out; and Miss Nightingale remarks on the vast proportion who are not convalescents, and never can be, under such circumstances. I might fill columns with such painful details; but in charity to my readers I will turn from the subject. It is plain that no Hospital System, worthy of the name, can exist under any authority short of one which is competent to institute a proper training for a body of nurses (regimental, or civil, or female nurses, according to the character of the hospital), and to erect buildings, and to organise the staff of management and attendance; and to provide for convalescents during their stage of recovery. The mere provision of food requires such an authority; for, as Miss Nightingale observes, the office of purveyor (which requires training) is necessary even at home.
"In England, where the grass-meat is so much better than in India, it is found necessary to put the purveying of meat for hospitals under the charge of the Purveyor, for the sake of always obtaining the best quality." In India, all is under the Commissariat; and while that continues to be the case, it is best not to inquire about "diets" as an article of hospital provision, or to look too closely into what is offered to the feeble appetite of the sick. "In India," says Miss Nightingale, "the chief quality in native cooks appears to be 'the pursuit of cooking under difficulties;' their ingenuity in bringing about an apparently good result, in a rude and often bad way, is frequently admired by the reporters, as if the end of cooking were 'to make a pair of old boots look like a beef-steak.'"
The commonest question, perhaps, that is asked in connection with this great new proposal of extinguishing the extra mortality of India,—of saving four-fifths of the lives now sacrificed in our army there by mismanagement, or want of management—is—"How are we to draw the line in this respect between our army and all the other inhabitants?"
The answer is that no such line will be attempted to be drawn, for the simple reason that no division of the kind can be made. Why should it be made? When taking in hand the broad conditions of public health,—the soil, the water, the air,—why not perfect them for the benefit of the whole community, as well as for any class? The personal matters of the soldier,—his food and drink, his barracks or his tent, his clothing, his occupation and amusement, his training, and the care of his domestic interests, form a part of the objects of the new system; but not the whole, and not an attainable part, unless the larger conditions are fulfilled, from which the civilians and natives cannot be excluded. On the other hand, nothing effectual can be done for the soldiery till the towns and bazaars, the tanks and rivers and wells, and the festering soil, are purified, and put under guardianship. The natives die off unnecessarily, at present, as our soldiers do. Though born to "the heat of India," they die faster than our soldiers when living under worse influences, and live longer if under better than they. The deaths of our men from wounds and the special fatigues of war, form at worst a very small proportion of the mortality of any year; and their liabilities are essentially those of the natives, besides being largely dependent on the customs and manners of native life. Both must, therefore, be provided for together; and the Presidential Commissioners will undertake the charge of the whole society within their area, as the Health officers, under the Home-office, do in England.
The case is fully set forth; the facts are made clear beyond dispute: and if Miss Nightingale's Observations were within reach of the English public, there would be no doubt of the immediate institution of a Health Department. The danger is the common one in such cases,—of obstruction in high places, arising from the repugnance of old-fashioned officials to changes of plan, and to any virtual confession that things have not hitherto gone so well as they might have done. The facts must prevail in the long run. It is impossible to dispute them to any purpose,—beyond that of securing delay. It is for English opinion and English will to decide between life and death for tens of thousands of our fellow-subjects: and the national will ought to be quickened and strengthened by the consideration that every month of delay is a death sentence upon whole battalions of men who have pledged their lives in the defence of ours, and of our common country.
From the Mountain.