Chapter 6 No.6

Few of my readers have come to close quarters, I suppose, with the Indian Sanitary Commission's Report. It is a very formidable thing, consisting of two bulky volumes, containing respectively 1069 and 959 pages-in all 2028 pages, mostly in small print. Of this mountainous mass, the greater part bears in one way or another the impress of Miss Nightingale. It was she, in the first place, as already stated, who drafted the questions which were sent to every military station in India.

The replies, signed in each case by the commanding officer, the engineer officer, and the medical officer, occupy the whole of the second volume. The replies, as they came in from India, were sent to her to analyse. There were van-loads of them, she said, which cost her ￡4:10s. to move whenever she changed houses. With the analysis made by her and Dr. Sutherland, these replies anticipated, as she afterwards noted,[10] the Statistical Survey of India which Lord Mayo ordered ten years later. It was said at the time that such a complete picture of life in India, both British and native, was contained in no other book in existence. In October 1861 she was formally requested by the Commission to submit remarks on these Stational Reports. She had completed the task by August 1862. The "Observations by Miss Nightingale," which occupy twenty-three pages of the Report, are among the most remarkable of her Works, and in their results among the most beneficent. They are also extremely readable; and to make them more instructive, she included a number of woodcuts illustrating, not only Indian hospitals and barracks, but native customs in connection with water-supply and drainage.[11] The Treasury-horrified perhaps at the idea of popularizing a Blue-book-made some demur to the cost, but Miss Nightingale was allowed to solve the difficulty by paying for the printing, as well as for the illustrations, out of her private purse.

She made full use of the opening which the niggardliness of the Treasury gave her. She hurried the printers, and had a large number of her "Observations" struck off for private use. "I have looked once more," wrote Lord Stanley (Nov. 21), "through your Remarks, and like them better the oftener I read them. The style alone (apart from the authority which your name carries with it) will ensure their being studied by many who know nothing of the subject. They will admirably relieve the dryness of our official Report. I hope every Indian and English newspaper will reprint them, in extracts at least. They must be circulated with our Report, separately from the too voluminous mass of evidence which we can't help appending. You have added one more to your many and invaluable services in the cause." "Miss Nightingale's Paper," wrote Dr. Farr to Dr. Sutherland (Dec. 1), "is a masterpiece, in her best style; and will rile the enemy very considerable-all for his good, poor creature."[12] But it was not only among the Commissioners that she circulated her Paper. She sent it confidentially to many of her influential friends. "The picture is terrible," wrote Sir John McNeill (Aug. 9), "but it is all true. There is no one statement from beginning to end that I feel disposed to question, and there are many which my own observation and experience enable me to confirm." A copy went to John Stuart Mill, who was much pleased with the "Observations," and was certain that "the publication of them would do vast good." Miss Nightingale had a copy bound for the Queen, and sent it-as also a copy of her Paper on Sidney Herbert-through Sir James Clark, who marked passages for the Queen to read. Her Majesty, he found from conversation, had not confined her reading to those passages. The Queen in return sent a copy of her Collection of Prince Albert's Speeches. "The Queen," wrote Miss Nightingale to M. Mohl (Feb. 14, 1863), "has sent me her book with such a touching inscription. She always reminds me of the Greek chorus with her hands clasped above her head wailing out her irrepressible despair."[13] Miss Nightingale sent her "Observations" also to Sir John Lawrence, who studied them closely, and corresponded with her on the subject. Another copy went to Sir Charles Trevelyan.[14] "Having," he wrote (Oct. 31, 1862), "undertaken the duties of Financial Member of the Council of India, I may now be able to give some help in carrying the recommendations of your Commission into practical effect. You must not expect from me as much as Sidney Herbert did, for my power will not be the same. The Governor-General and the local Governors will alone be in that position. But I shall do what I can. Perhaps you will send me a copy of your Abstract of the Evidence, and direct my attention to the points of more immediate importance. I shall be obliged for any hints." Miss Nightingale responded by sending him papers enough to occupy all his time on the voyage. She seems at this time to have entertained some hope that her health would permit her, when the Report was out, to visit India in person; for one of Sir Charles's letters refers to such a visit, and expresses the pleasure which it would give to Lady Trevelyan and himself to receive her as their guest, and in every way to assist her mission. But this was not to be. Her knowledge of India and Indian questions was already great, and presently it became so minute as to encourage a legend that she herself had once been there.[15] But she never saw the country. It is not always either the "life-long resident," or, on the other hand, "Padgett, M.P.," who is better qualified than the student to perceive and serve a country's need.

Miss Nightingale's "Observations" form a synopsis of the whole subject. Giving chapter and verse from the Stational reports for each of her statements, she shows, first, that the prevailing diseases were camp diseases such as she had seen in the Crimean War-largely due to the selection of unsuitable sites. Among the causes were Bad Water, Bad Drainage, Filthy Bazaars, Want of Ventilation, and Surface Overcrowding in barrack-huts and sick-wards. Her remarks under these several heads are often characteristically racy. "Where tests have been used, the composition of the water reads like a very intricate prescription, containing nearly all the chlorides, sulphates, nitrates, and carbonates in the pharmacopoeia, besides silica and quantities of animal and vegetable matter, which the reports apparently consider nutritive." "If the facilities for washing were as great as those for drink, our Indian army would be the cleanest body of men in the world." "There is no drainage, in any sense in which we understand the word. The reports speak of cesspits as if they were dressingrooms." "Except where the two Lawrences have been-there one can always recognize their traces-the bazaars are simply in the first savage stage of social savage life." Under the head of "Overcrowding," she brings together various instances with figures and woodcuts; she quotes one report which said that the men (300 men per room!) "are generally accommodated in the barrack without inconvenient overcrowding," and she asks, "What is convenient overcrowding?" "At some stations the floors are of earth, varnished over periodically with cow-dung: a practice borrowed from the natives. Like Mahomet and the mountain, if men won't go to the dunghill, the dunghill, it appears, comes to them." Her next section, on "Intemperance," is scathing. In India, as at home,[16] it was a current opinion of the time that the soldier is by nature a drunken animal; the only question seemed to be as to how he had better get drunk. At one station, though the men were reported as "mostly temperate," she found that on a ten years' average one man in three was admitted into hospital directly from drink. "The men are killed by liver disease on canteen spirits to save them from being killed by liver disease on bazaar spirits. May there not be some middle course whereby the men may be killed by neither?" Under "Diet," she notes the absurdity of a uniform ration, in amount and quality, in all seasons and climates; and ventures to doubt whether cesspits are desirable adjuncts of kitchens. Her next head is "Want of Occupation and Exercise"-a fruitful source of vice and disease. It is a most interesting chapter, full of valuable hints and illustrated by an amusing drawing, sent to her by Colonel Young, of "Daily Means of Occupation and Amusement passim." Here, as in much else of Miss Nightingale's work, she collected all the better opinions; she picked out from the returns before her any hopeful experiments; enlarged upon them, and drove the moral home. Her chapter on "Indian Hospitals" is naturally very full and detailed. She discusses the prevalent structural defects; suggests improvements in the internal arrangements; and notes that there were "neither trained orderlies nor female nurses." On the subject of "Hill Stations," Miss Nightingale's "Observations" show a fear lest too much reliance should be placed upon their superior salubrity. She quotes instances of terrible sanitary defects on hill stations, and enforces the moral that "the salvation of the Indian army must be brought about by sanitary measures everywhere." After discussing "Native Towns," "Soldiers' Wives," and "Statistics," Miss Nightingale insisted generally on the importance of instituting a proper system of sanitary service in India. Henceforth, to the end almost of her long life, she regarded herself, and in large measure was able to act, as a sanitary servant to the army and peoples of India.

Miss Nightingale's "Observations" were only part of her share in the labours of the Commission. They were followed in the Report by an Abstract, arranged under Presidencies, of the Returns on which the "Observations" were founded. This analysis, occupying nearly a hundred pages, was drawn up, as already stated, by Miss Nightingale and Dr. Sutherland. The manuscript of it, preserved amongst her papers, is mainly in her handwriting. And she did much more, as will presently be related.