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Angels & Orderlies

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Nurses, Orderlies and the Civil Hospital

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Introduction

This short article paints a picture of the Angels and Orderlies and their workplace in the East during the Crimean War - the Civil Hospital at Renkioi. The story of Florence Nightingale is well known [1, 2], and is not repeated in detail here.

The Crimean nursing adventure

In the period June to August 1854, before the first battle of the Crimea had commenced, over half the British army in the Crimea was suffering from Cholera or similar gastric infections. The causes of Cholera had not been identified, and army surgeons believed it was caused by excess stomach acid or panic attacks - so the conditions that caused the spread of the disease were allowed to continue. Once battle commenced, the wounded were taken by hospital ship to the base hospital at Scutari, opposite Constantinople. There the wounded joined those being treated for illness. The hospital medical corps, composed of army field surgeons and orderlies, was overwhelmed. Even then, however, they did not make a request for female nursing assistance.

The initial quota of nurses were sent out after The Times' War Correspondent, William Russell, set off a chain of correspondence in The Times, one asking why the British did not have their own equivalent of the French 'Sisters of Charity' who nursed the French Army. Florence Nightingale stepped forward and exchanged letters with War Secretary Sidney Herbert, offering her services and that of a small private expedition of nurses to serve at the base hospital in Scutari, as Nightingale claimed it would be "impossible to carry a large number of nurses in the field". On the 15th October 1854, Herbert wrote to Nightingale and asked her to organise a party of nurses willing to serve in Scutari:

The difficulty in finding women equal to the task after all full of horror, requiring besides knowledge and good will, great energy and great courage, will be great. The task of ruling them and introducing system among them, is great; and not the least will be the difficulty of making the whole work smoothly with the medical and military authorities out there [3].

The first party of nurses to be sent the East consisted of 14 Anglican nurses, 10 nuns and 14 secular nurses. The selection team included Mary Stanley and Lizzie Herbert, wife of Stanley Herbert. Mary Stanley in particular believed that nursing was a pastoral occupation, invoking a spiritual calling. She had great problems in selecting nurses outside of religious institutions, claiming to have scoured London for suitable applicants:

We felt ashamed to have in the house such women who came … Money was the only inducement [4, page 38].

The records that survive show that many of the original applicants were widows who badly needed money to support large families. Nursing was apparently not a profession that someone would enter if they were not desperate for employment.

The despatch of the first party of female nurses to the Crimea caught the public's imagination and steady stream of applications poured in for Mary Stanley and Lizzie Herbert to sort through. Ann Summers suggests that the upper class interviewers struggled to come to terms with lower class women. They had had no previous contact with nurses and had been expecting the "deference and submission" they received from their own domestic servants. They did not get this respect. Indeed Summers states that the selected secular nurses "inspired alarm and distrust amongst their female employers", with one nurse being sent home from the Crimea for "lightness of behaviour" and another for "keeping bad company" [4, pages 39-40].

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The Civil Hospital at Renkioi

As the war in the east continued, it became clear that there was a need for purpose-built hospital accommodation. The base hospital occupied the old barracks at Scutari and, despite the efforts of the medical officers and Florence Nightingale's nursing staff, conditions there were appalling [6, pages 23-30].

Field hospitals occupied tents and huts. The need for the new hospital was so urgent that Isambard Kingdom Brunel designed an innovative pre-fabricated building. Work had started in England by March 1855, long before its eventual site was selected in May 1855 [7].

Renkioi Hospital was located on the shores of Renkioi Bay, 150 miles to the south west of Scutari and over 100 miles north of another British hospital at Smyrna. Thirteen sites were surveyed including Scutari, but Renkioi was the only location with suitable terrain, access to fresh water and with docking piers for ships. The first consignment was unloaded there on 7th May just three months after Brunel was awarded the contract to build the hospital. The new hospital was set up under civilian control during the summer of 1855 [8, 9].

The ward buildings each measured 100 feet by 44 feet and were tin with felt roofs. They were connected by a corridor, half a mile long. Each ward was to be self-contained with its own bathrooms, nurse's rooms, water closets and drainage systems. There were also two large, store houses with tiled roofs and four corrugated iron kitchens with boilers, ranges, ovens and dressers, capable of cooking food for 700 patients [10, 11].

Florence Nightingale was said to have approved of the 22-ward building, which was planned with hygiene in mind, and she referred to Renkioi as "those magnificent huts", although it was also said that she was not happy that the nurses at Renkioi were not to be under her control. Once the Crimean War was over, however, the hospital was surplus to requirements and closed down. It was only in operation from October 1855 until June 1856, yet in that time it treated 1408 patients, with just 50 recorded deaths [12]. Of those deaths, 22 were from typhus, 14 from dysentery, 8 from pulmonary tuberculosis and 6 from miscellaneous conditions.

The contrast with the hospital at Scutari was great. In her first letter back to England, Nightingale wrote that "we have not an average of three limbs per man … we have four miles of beds not eighteen inches apart". There was no hygiene system - neither men nor bed linen were washed during Nightingale's first three weeks; there were no plates, spoons, scissors, towels, basins, soap, lime or chloride. The water allowance was one pint per person per day for all purposes. Staff were allocated one small bowl for eating, drinking and washing. Patients were allocated one basin per ward and "when it went astray one day there was general despair" [13]. Prior to Nightingale's arrival, orders had been given that 30 patients were to be bathed every night. Nightingale calculated that this would result in each man having a wash once every 80 days! Nightingale took it upon herself to make improved hygiene standards and supplies of essential goods a necessity.

The new Civil Hospital at Renkioi was a great improvement. Its only drawback was its distance from the battlefields. Contemporary records show that the majority of patients admitted to Renkioi were suffering from infections, diseases such as Typhus and Cholera and illnesses such as Gout and Ague.

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Angels and orderlies

Sir James Clarke (First physician to Queen Victoria) and Dr Edmund Parkes (the superintendent of the Civil Hospital) selected nurses for the Civil Hospital at Renkioi. The Matron of St George's Hospital was placed in charge of the detailed arrangements.

Many miles south of Scutari, at Renkioi, female nurses, recruited and equipped uniformly with those in military hospitals, were also employed in hospitals established on civilian initiative [4, page 44].

There is very little information about individual nurses at the Civil Hospital. However, information does survive about the general life of the nurses at Renkioi, taken from the quaint but authoritative "Rules and Regulations for the Nurses", issued because:

… the Nurses who have gone to Hospitals in the East have in some instances complained of being subjected to hardships and to rules for which they were not previously prepared, and of having to do work differing from what they had expected, it has been thought desirable to state distinctly the regulations relative to the outfit, clothing, duties and position of Nurses in Military Hospitals [14].

The Rules and Regulations included a full uniform list. This ensured that the nurses would be equipped for extremes of temperatures, since the winters in Turkey were harsh and the summers hot. In February 1856 it had been windy and stormy with an average temperature of 40F (although the temperature in the wards averaged 53 F) whereas in October 1855 it had been 81F in the shade [12].

The nurse's duties were to do whatever the Superintendent required. This would include not only nursing the patients, but needlework, cooking, laundry and any other household duties required. An article in The Quiver, published to coincide with the granting of the Freedom of the City of London to Florence Nightingale, rather glorifies the role of the "heroines of the Crimea" claiming:

They stood beside the bedside of many a gallant soldier in the horrible war of 50 years ago, cheering his last hours and assuaging his pain with whatever appliances - alas! Too few - lay to their hand [15].

The fact that the nurses were allowed little contact with the male patients and that much of their work was menial labour is often overlooked.

Nurses were also under strict orders to remember their position in life and not imagine themselves being raised to any elevated status through their employment. This was because:

It having been found that some of the Nurses have believed they were to be on an equality with the Ladies or Sisters, it is necessary that they understand that they will remain in exactly the same relative position as that in which they were in England [13].

The orderlies at Renkioi were civilians. Elsewhere, at Scutari and in the field camps and hospitals ships, convalescent soldiers deemed unfit for active duty filled the posts of orderlies. The military orderlies on the whole did not have a good reputation. Unfit for duty could sometimes be roughly translated as too drunk for duty. There was also a problem with petty thieving, with orderlies being accused of stealing money and possessions from dying men. The civilian orderlies seem to have gained a better reputation. A report in October 1855, shortly after Renkioi accepted its first patients, said that the orderlies were inexperienced but performing their parts with a high degree of success [12]. Their duties included cleaning, dispensing, kitchen and stores work - and any tending of the male patients deemed unsuitable for a lady. For example the orderlies, not the nurses, walked the wards at night.

This is a brief outline of the duties and working conditions for nurses and orderlies at the Civil Hospital. There is a detailed account of the personal and working life of a Civil Hospital nurse in my biography of Ann Newman.

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References

  1. Woodham-Smith, Cecil, Florence Nightingale 1820-1910 (Constable, London, 1950)
  2. Small, Hugh, Florence Nightingale, Avenging Angel (Constable, London, 1998)
  3. Letter from Herbert to Nightingale, 1854
  4. Summers, Anne, Angels and Citizens, British Women as Military Nurses 1854-1914 (Routledge & Kegan Paul, 1988)
  5. Letter written by Edmund Parkes announcing the selection of Renkioi as the site for the Civil Hospital, 5 May 1855, WO 43/991 folios 26-29, The National Archives, United Kingdom
  6. Cooke, Brian, Isambard Kingdom Brunel and Renkioi Hospital, The Journal of the Crimean War Research Society: The War Correspondent, Volume 16, Number 2, July 1998, pp18-21
  7. Anon, Brunel Biography, 2006, http://www.brunel200.com/index.htm
  8. Sale of the British Hospital at Renkioi near the Dardanelles. WO WO43/991 folio 239, The National Archives, United Kingdom
  9. Urry, Syd, Article about Brunel, Graduate Link Magazine (Brunel University, 1995)
  10. Monthly reports of the Civil Hospital at Renkioi, WO43/991, The National Archives, United Kingdom
  11. Ken Horton, Nurses of the Crimean War, The Nightingale, magazine of the Florence Nightingale Museum, Spring/Summer 2002
  12. Rules and Regulations for the Nurses attached to the Military Hospitals in the East, WO 43/963 folio 247, The National Archives, United Kingdom
  13. Billington, Mary Frances, Surviving Crimean Nurses, The Quiver, Annual Volume 1908 (Cassell and Company. London), pp738-744

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