The British were far behind the French in their medical arrangements for the sick and wounded. Visitors to the French military hospitals in the Crimea and Constantinople were impressed by their cleanliness and good order. There were teams of nurses, mostly nuns recruited from the Order of St Vincent de Paul, operating under instructions from the doctors. ‘We found things here in far better condition than at Scutari,’ wrote one English visitor of the hospital in Constantinople:
There was more cleanliness, comfort and attention; the beds were nicer and better arranged. The ventilation was excellent, and, as far as we could see or learn, there was no want of anything. The chief custody of some of the more dangerously wounded was confided to Sisters of Charity, of which an order (St Vincent de Paul) is founded here. The courage, energy and patience of these excellent women are said to be beyond all praise. At Scutari all was dull and silent. Grim and terrible would be almost still better words. Here I saw all was life and gaiety. These were my old friends the French soldiers, playing at dominoes by their bed-sides, and twisting paper cigarettes or disputing together … I liked also to listen to the agreeable manner in which the doctor spoke to them. ‘Mon garçon’ or ‘mon brave’ quite lit up when he came near.
Captain Herbé was evacuated to the hospital later in the year. He described its regime in a letter to his family:
Chocolate in the morning, lunch at 10 o’clock, and dinner at 5. The doctor comes before 10 o’clock, with another round at 4. Here is this morning’s lunch menu:
Très bon potage au tapioca
Côtelette de mouton jardinière
Volaille rotie
Pommes de terre roties
Vin de Bordeaux de bonne qualité en carafe
Raisins frais et biscuits
Seasoned by the sea wind that breezes through our large windows, this menu is, as you can imagine, very comforting, and should soon restore our health.18
French death rates from wounds and diseases were considerably lower than British rates during the first winter of the war (but not the second, when French losses from disease were horrendous). Apart from the cleanliness of the French hospitals, the key factor was having treatment centres near the front and medical auxiliaries in every regiment, soldiers with first-aid training (soldats panseurs) who could help their wounded comrades in the field. The great mistake of the British was to transport most of their sick and wounded from the Crimea to Scutari – a long and uncomfortable journey on overcrowded transport ships that seldom had more than a couple of medical officers on board. Raglan had decided on this policy on purely military grounds (‘not to have the wounded in the way’) and would not listen to protests that the wounded and the sick were in no state to make such a long journey and needed treatment as soon as possible. On one ship, Arthur the Great, 384 wounded were laid out on the decks, packed as close as possible, much as it was on the slave ships, the dead and dying lying side by side with the wounded and the sick, without bedding, pillows or blankets, water bowls or bedpans, food or medicines, except those in the ship’s chest, which the captain would not allow to be used. Fearing the spread of cholera, the navy’s principal agent of transports, Captain Peter Christie, ordered all the stricken men to be put on board a single ship, the Kangaroo, which was able to accommodate, at best, 250 men, but by the time it was ready to sail for Scutari, perhaps 500 were packed on board. ‘A frightful scene presented itself, with the dead and dying, the sick and convalescent lying all together on the deck piled higgledy-piggledy,’ in the words of Henry Sylvester, a 23-year-old assistant surgeon and one of just two medical officers on the ship. The captain refused to put to sea with such an overcrowded ship, but eventually the Kangaroo sailed with almost 800 patients on board, though without Sylvester, who sailed for Scutari aboard the Dunbar. The death toll on these ships was appalling: on the Kangaroo and Arthur the Great, there were forty-five deaths on board on each ship; on the Caduceus, one-third of the passengers died before they reached the hospitals of Scutari.19
The Russians, too, understood the need to treat the wounded as soon as possible, although conditions in their hospitals were far worse than anything that Florence Nightingale would find in Scutari. Indeed, it was a Russian, Nikolai Pirogov, who pioneered the system of field surgery that other nations came to only in the First World War. Although little known outside Russia, where he is considered a national hero, Pirogov’s contribution to battlefield medicine is as significant as anything achieved by Florence Nightingale during the Crimean War, if not more so.
Nikolai Pirogov
Born in Moscow in 1810, Pirogov began his medical studies at Moscow University at the age of just 14, and became a professor at the German University of Dorpat at the age of 25, before taking up the appointment of Professor of Surgery at the Academy of Military Medicine in St Petersburg. In 1847 he was with the Russian army in the Caucasus, where he pioneered the use of ether, becoming the first surgeon to employ anaesthesia in a field operation. Pirogov reported on the benefits of ether in several Russian-language publications between 1847 and 1852, though few doctors outside Russia were aware of his articles. Apart from the relief of pain and shock through anaesthesia, Pirogov emphasized that giving ether to the wounded on arrival at the hospital kept them calm and stopped them from collapsing so that the surgeon could make a better choice in selecting between those cases requiring urgent operation and those that could wait. It was this system of triage pioneered by Pirogov during the Crimean War that marked his greatest achievement.
Pirogov arrived in the Crimea in December 1854. He was outraged by the chaos and inhuman treatment of the sick and wounded. Thousands of injured soldiers had been evacuated to Perekop on open carts in freezing temperatures, many of them arriving frozen to death or with limbs so frostbitten that they had to be cut off. Others were abandoned in dirty barns or left by the roadside for lack of transport. There were chronic shortages of medical supplies, not least because of corruption. Doctors sold off medicines and gave their patients cheaper surrogates, exacting bribes for proper treatment. The hospitals struggled to cope with the enormous numbers of wounded. At the time of the allied landings, the Russians had hospital places for 2,000 soldiers in the Crimea, but after Alma they were overwhelmed by 6,000 wounded men, and twice that number after Inkerman.20
Conditions in the Sevastopol hospitals were truly appalling. Two weeks after the battle of the Alma, the surgeon from Chodasiewicz’s regiment visited the naval hospitaclass="underline"
He found the place full of wounded men who had never had their wounds dressed from the day of the Alma, except such dressings as they could make themselves by tearing up their own shirts. The moment he entered the room he was surrounded by a crowd of these miserable creatures, who had recognized him as a doctor, some of whom held out mutilated stumps of arms wrapped up in dirty rags, and crying out to him for assistance. The stench of the place was dreadful.