Florence Nightingale and Hospital Reform: Collected Works of Florence Nightingale, Volume 16

Military Hospitals: Letters, Notes, Articles and Reports

Military Hospitals: Letters, Notes, Articles and Reports Herbert Hospital, Woolwich, the model army pavilion hospital designed by Douglas Galton, with much input from Nightingale; the narrow ‘‘spokes’’ were wards, with a row of beds on each side, windows facing each other for cross-ventilation, now private residences, the ‘‘Royal Herbert Pavilions’’ (see picture p 493). From The Builder 14 April 1866, 269. 232 / Military Hospitals: Letters, Notes, Articles and Reports T he great impetus for Nightingale’s work on hospital reform came from her own experience of the horrendous defects in British Army hospitals during the Crimean War. The analysis she did to ascertain what went wrong in them led to her first papers on hospital reform, and in time to her comprehensive 1863 Notes on Hospitals. The similarities between civil and military hospitals are obvious from that early writing, and they appear again in the correspondence on civil hospitals later in this volume. However, a sufficient number of differences between the two remain to make a separate section on military hospitals useful. This section is also the place to report related health concerns in barracks and stations, and such issues as nutrition and healthier lifestyles for soldiers. As with civil hospitals, Nightingale considered better statistics to be crucial for planning reforms and tracking their implementation and results. The dominant concern in the period immediately following the Crimean War was the building of a new and massive hospital at Netley. Nightingale’s opposition to the project is clear right in her confidential report, Notes on the Health of the British Army. Correspondence here shows that she, with her team, initially tried to get the project cancelled, and then to have it modified substantially when it could not be stopped. Nightingale proposed making Netley into an invalid hospital or even a barrack instead of a full general hospital (see p 258 below), ideas which were again rejected. Correspondence here will show, however, that the team was successful in getting significant alterations made to the design. By 1 July 1857, Nightingale could describe the revised plans as having ‘‘very great improvements,’’ listing five crucial points (see p 253 below). In January 1858, she went so far as to declare the hospital to be ‘‘not now’’ unhealthy, although not what ‘‘a great military hospital of the British Empire should be’’ (see p 258 below). The assessment of Nightingale’s Netley work as being one of her ‘‘recorded / 233 failures’’ seems to have missed the point, given how much change was achieved.1 The impetus for building Netley on such a grand scale came from the director general of the Army Medical Department, Andrew Smith, who also strongly defended the estuary site.2 In March 1855, while the Crimean War was still producing large numbers of sick and invalids, the war secretary, Lord Panmure (1801-74), instructed Sir John Burgoyne (1782-1871), inspector general of fortifications, to appoint an officer to assist in the selection of a site for a new military hospital to accommodate 1000 patients. Appointed was Captain Robert Michael Laffan (c1821-82), r.e., who, with Dr Henry Mapleton (1815-79), head of the Medical Board at the War Office, looked at potential sites in the Portsmouth area. Sir James Clark (1788-1870), a Nightingale ally, objected to the first site selected as being too close to the Naval Hospital at Haslar. Clark marked a map for Laffan at what ultimately became the settled-on location, the ruins of an old abbey at Netley, on the south coast near Southampton. Laffan inspected and approved the proposed location, and a committee was established in January 1856 to prepare a plan. Panmure told it that the new hospital should be in a form like French pavilion hospitals such as Bordeaux. Andrew Smith, however, who opposed the pavilion model, succeeded in getting a quite different plan made of one vast building, 1400 ft. in length, with a central block and two long wings of 554 ft. each. The only ventilated wards were at the extreme ends of the two wings. The long corridors would facilitate the transmission of disease from ill-ventilated ward to ill-ventilated ward. Moreover, the wards were small, to accommodate twelve to sixteen patients each, a size Andrew Smith favoured, but one, from Nightingale’s perspective, that made them impossible to nurse. Separate kitchens, dining rooms and other offices were planned for each wing, adding to the expense...