CHAPTER III

PUBLIC HEALTH MISSIONARY FOR INDIA (1868-1872) There is a vast work going on in India, and the fruits will be reaped in time. Not all at once. We must go on working in faith and in hope.--DR. JOHN SUTHERLAND (_Letter to Miss Nightingale_, August 16, 1871). "By dint of remaining here for 13 months to dog the Minister I have got a little (not tart, but) Department all to myself, called 'Of Public Health, Civil and Military, for India,' with Sir B. Frere at the head of it. And I had the immense satisfaction 3 or 4 months ago of seeing 'Printed Despatch No. 1' of said Department. (I never, in all my life before, saw any Despatch, Paper or Minute under at least No. 77,981). Still you know this is not the meat, but only the smell of the meat. What we want is an Executive out there to do it, and a Department here to see that it is being done. The latter we now have; the former must still rest with the Viceroy and Council out there." Thus did Miss Nightingale, in a letter to M. Mohl (Feb. 16, 1868), sum up the results of the campaign described in the last chapter. Her life, for some years to come, was now largely occupied with the affairs of the "little Department all to herself." The Department may have been little, but she interpreted her duties, as we shall see, in a large sense. Her work in connection with the War Office, though it did not entirely cease, was no longer absorbing. She had ceased to have direct communications with the Secretaries for War. In 1868 there was one of the periodical reorganizations of the War Office, followed in the succeeding year by the retirement of Captain Galton.[100] She had thus no longer a confidential intimate in the Department. She could have made one, perhaps, if she had so desired; for her Scutari friend, Sir Henry Storks, had now been appointed to the newly organized post of Controller-in-Chief, and presently became Surveyor-General of Ordnance. But her Indian preoccupations, coupled with the never-ceasing strain of work as Adviser-in-General on Hospitals and Nursing, used all her strength. In the present chapter we shall follow the course of her life during the years 1868-72, with special reference to Indian work; in the next, we shall follow the development of her work in connection with hospitals and nursing. [100] He retired at the end of 1869, and was appointed to a post in the Office of Works. Miss Nightingale intervened (through representations to Lord de Grey and Mr. Cardwell) to secure his continuance as a member of the Army Sanitary Committee. * * * * * The long strain, mentioned in the letter to M. Mohl, had told severely upon Miss Nightingale's strength, and at the end of December 1867 she went, leaving no address behind (except with Dr. Sutherland), for a month's rest-cure under Dr. Walter Johnson at Malvern. Upon her return to London she was busily engaged in the preparation of the Indian "Memorandum" described in the last chapter. The death of Miss Agnes Jones and the anxieties which it entailed (chap. i.) told greatly upon her health and spirits. Mr. Jowett, after seeing her early in July, was seriously alarmed at her state of physical weakness and mental despondency. She had half promised him that she would go for rest and change to Lea Hurst; but only if the rest were accompanied by a duty of affection. If her mother were at Lea Hurst, she would go; if not, she would not. So Mr. Jowett wrote privately to Mrs. Nightingale, who arranged her plans accordingly, and begged her daughter to come and be with her. They were together at the old home for three months (July 7-Oct. 3), and for a week of the time Mr. Jowett was with them. The mother and the daughter had seldom been on such affectionate and understanding terms as now. "Mama," wrote Miss Nightingale to Madame Mohl (July 20), "is more cheerful, more gentle than I ever remember her." The daughter's note of conversations shows that they talked of misunderstandings in the past, and that the mother was ready to blame herself: "You would have done nothing in life, if you had not resisted me." For many years to come, Miss Nightingale repeated such visits to the country homes of her parents. They were now old; her father was 74 in 1868, her mother 80. The daughter desired to be with them so far as her work allowed. Perhaps something was due also to the persistent counsels of Mr. Jowett. Continuous drudgery in London was not good, he pleaded, either for her body or for her soul. They were supposed to have entered into a compact not to overwork. He avowed that he was faithfully keeping his side of the bargain, and put her upon her honour to do her part in return. It was an unhealthy life, he pleaded, to be shut up all the year in a London room. There was still much for her to do, and she would do it all the better for some relaxation of daily effort. Perhaps he persuaded her. At any rate, from 1868 for some years onwards there was more of the country in Miss Nightingale's life--less of incessant drudgery, more leisure for reading, more marge for meditation. In 1869 she was at Embley for three months in the summer; in 1870, at Embley for one month, and at Lea Hurst for three; in 1871, there was a similar division of time; in 1872 she was at Embley for eight months. II Mr. Jowett was often a visitor on these occasions for a few days at a time. He continued in frequent letters to urge her to attempt some sustained writing. She had a talent for it, he insisted, and she was possessed of great influence. He suggested as a subject suitable to her a Treatise on the Reform of the Poor Law, and he sent her a memorandum of his own ideas on the subject. There are one or two of Mr. Jowett's ideas, and occasionally a phrase of his, in what she ultimately wrote. She endeavoured to take his advice, and a resolve is recorded in her diary for 1868 to devote an hour a day to writing. The projected work went to no further length than that of a magazine article entitled "A Note on Pauperism." Nothing that she ever wrote--with one exception[101]--cost her so much worry and trouble. She did what is always trying to an author's equanimity and often prejudicial to the effect of his work: she admitted collaboration. Dr. Sutherland had a hand in it--that goes without saying, and his assistance was always useful: he knew exactly within what limits he could really help his friend. But her brother-in-law was an authority on the subject and Lady Verney claimed (and not without justice) to be an authority on the style appropriate to magazine articles. She took much well-meant trouble, and transcribed her sister's first draft in her own hand, with corrections of her own also. The authoress was in despair, and sent again for Dr. Sutherland: "I have adopted _all_ your corrections, and _all_ Parthe's, and _all_ Sir Harry's; and they have taken out all my _bons mots_ and left unfinished sentences on every page; and this _kind_ of work really takes a year's strength out of me; and now you _must_ help me." So, Dr. Sutherland patched up the broken sentences and harmonized the corrections, and the article was ready. Miss Nightingale was as timid and perplexed as any literary beginner about placing her paper. After much consultation she decided to submit it to Mr. Froude, with whom as yet she had no acquaintance. She was as pleased as any literary beginner when the editor replied immediately that he would be delighted to print the paper in his next number. In _Fraser_ for March 1869 it appeared accordingly--the first of several contributions which she made to that magazine. The "Note" is somewhat disconnected in style and slight in treatment, but is full of far-reaching suggestions. She begins by insisting on a reform of which we have heard much in a previous chapter: the separation of the sick and incapable from the workhouse. Then she goes on to argue that the thing to do is "not to punish the hungry for being hungry, but to teach the hungry to feed themselves." She attacks the _laisser faire_ school of economists, "which being interpreted means Let bad alone." Political economy speaks of labour as mobile, and she quotes a leading article in the _Times_ which had talked about "the convenience in the possession of a vast industrial army, ready for any work, and chargeable on the public when its work is no longer wanted." She stigmatizes such talk as false, in the first case, and wicked, in the second. The State should endeavour to facilitate the organization of labour. "Where work is in one place, and labour in another, it should bring them together." Education should be more manual, and less literary. Pauper children should be boarded out and sent to industrial schools. The condition of the dwellings of the poor is at the root of much pauperism, and the State should remedy it. There should be State-aided colonization, so as to bring the landless man to the manless lands. Some of all this was not so familiar in 1869 as it is to-day, and Miss Nightingale's "Note" attracted much attention. Among those who read it with hearty approval was Carlyle. "Last night," wrote Mr. Rawlinson (March 11), "I spent several hours with Mr. Carlyle, and amongst talk about Lancashire Public Works, modern modes of government, modern Political Economy and Social Morality, he brought to my notice your 'Note on Pauperism' as in his opinion the best, because the most practical, paper he had read of late on the question. I wish you could have been present to have listened to the great man alternately pouring forth a living stream of information, and then bursting into a rhapsody of passionate denunciation of some thick-headed blundering statesmanship or indignant tirade against commercial rascality." Dr. Sutherland called to express his pleasure that the article had gone off so well. "Well!" she said; "it's not well at all. The whole of London is calling here to tell me they have got a depauperizing experiment, including that horrid woman." A large bundle of correspondence testifies to the interest which her paper aroused. Some of it was not disinterested. All the emigration societies read the paper with the gratitude which looks to subscriptions. The article was very expensive to her; for she gave away the editor's fee many times over in such contributions. For some years following, she took great interest in schemes for emigration, and nothing angered her more in the politics of the day than the absence of any Colonial Policy in the schemes and speeches of Liberal Ministers. [101] See below, p. 196. Miss Nightingale had sent some of her correspondence on colonization to an old friend at the Colonial Office--Sir Frederick Rogers (Lord Blachford). "See what a thing," he replied (July 26, 1869), "is a bad conscience! You, conscious of a life spent in bullying harmless Government offices, think that I must read your (beautiful) handwriting with horror. Whereas I, conscious of rectitude, have sincere pleasure in receiving your assaults." This was a preface to an essay in which the Under-Secretary demonstrated, in the manner habitual to the Colonial Office in those days, the utter undesirability, impropriety, and impossibility of doing anything at all. Lord Houghton raised a conversation on the subject in the House of Lords, but confessed to Miss Nightingale that he was half-hearted, and nothing came of it. She formed a large heap of newspaper cuttings, collected facts from foreign countries, made many notes, and intended to follow up the suggestions, thrown out in her paper, into greater detail, and then perhaps to publish a book. She gave much time during 1869 to the subject, and in December Mr. Goschen, the President of the Poor Law Board, came to see her. They had a long discussion, and her note of it begins with an _aperçu_ of the Minister--a little severe, perhaps, but not undiscriminating. "He is a man of considerable mind, great power of getting up statistical information and political economy, but with no practical insight or strength of character. It is an awkward mind--like a pudding in lumps. He is like a man who has been senior wrangler and never anything afterwards." He seemed to Miss Nightingale to see so many objections to any course as to make him likely to do nothing; and his economic doctrines paid too little regard, she thought, to the actual facts. "You must sometimes trample on the toes of Political Economists," she said,[102] "just to make them feel whether they are standing on firm ground." That she was deeply interested in the whole subject is shown by a testamentary document, dated September 19, 1869, in which she earnestly begged Dr. Sutherland to edit and publish her further "Notes on Pauperism."[103] She lived in full possession of her faculties for at least a quarter of a century after this date, but she never put the Notes into printable shape. As I have said before, she lacked inclination to sustained literary composition. Besides, her hands were full of other things. [102] In a letter to Madame Mohl, March 26, 1869. [103] In the same document Dr. Sutherland is begged to do the like for her (1) _Notes on Lying-in Hospitals_ (published in 1871; see below, p. 196), and (2) "Paper on selling lands with houses in towns" (see above, p. 92). At a later time she sent the second batch of Pauperism Notes to Dr. Sutherland; but he was of opinion that they required complete rewriting. III Miss Nightingale's main work during these years may be described as that of a Health Missionary for India. She carried on her mission in three ways. She endeavoured by personal interviews and correspondence to incense with a desire for sanitary improvement all Indian officials, from Governors-General to local officers of health, whom she could contrive to influence. She made acquaintance with natives of India and strove to spread her gospel among them in their own country. And through her "own little Department" in co-operation with Sir Bartle Frere she did a large amount of official work in the same direction. On her return to London at the beginning of October 1868, she found work awaiting her under the first of the foregoing heads. Sir John Lawrence's term of office of Governor-General was coming to an end, and Disraeli had appointed Lord Mayo to succeed him. On October 22 he wrote asking to be allowed to see Miss Nightingale before he sailed for India:-- (_Sir Bartle Frere to Miss Nightingale._) INDIA OFFICE, _Oct._ 23 [1868]. I think you will hear from Lord Mayo, who I know is anxious to see you, if you can grant him an interview next week. Could you in the meantime note down for him, as you did (when describing what the folk in India should now do) in a note to me a few weeks ago, the points to which he should give attention? I think you will like him very much. In appearance he is a refined likeness of what I remember of O'Connell when I went as a boy (with a proper horror of his principles) to hear him before he got into Parliament. Lord Mayo is very pleasing in manner, with no assumption of "knowing all about it," and evidently better informed on many subjects connected with sanitary reform than many men of greater pretension. He has a great sense of humour, too, which is a great help. I wish, when you see him, you would ask to see Lady Mayo. The interview with Lord Mayo was on the 28th, and a few days later Miss Nightingale saw Lady Mayo also. On the morning of the 28th Dr. Sutherland was summoned to South Street. He was in a hurry and hoped there was "nothing much on to-day." "There is a 'something,'" ran the message sent down to him, "which most people would think a very big thing indeed. And that is seeing the Viceroy or Sacred Animal of India. I made him go to Shoeburyness yesterday and come to me this afternoon, because I could not see him unless you give me some kind of general idea what to state." Dr. Sutherland, thus prettily flattered, stayed, and they discussed what should be said to the Sacred Animal. Next day she reported the conversation to Dr. Sutherland:-- What he said was not unsensible but essentially Irish. He said that he should see Sir J. Lawrence for two days before he (Sir J. L.) left. And he said he should ask Sir J. L. to call upon me the moment he returned, and to ask _me_ to write out to _him_ (Lord Mayo) anything that Sir J. L. thought "a new broom" could do. That was clever of him. But he asked me (over and over again) that I should now at once before he goes write down for him something (he said) "that would guide me upon the sanitary administration as soon as I arrive." And "especially (he said) about that Executive." He asked most sagacious questions about all the men. Miss Nightingale took counsel with Sir Bartle Frere and Dr. Sutherland and then wrote a Memorandum for the new Viceroy. She covered the whole ground of sanitary improvement, dwelling much on questions of irrigation and agricultural development as aids thereto. "A noble and a most complete Paper," said Sir Bartle Frere (Nov. 1), "and it will be invaluable to India." Perhaps it impressed the new Viceroy also. At any rate Lord Mayo's administration was marked by some improvement in sanitary conditions, and by extension of irrigation works.[104] He also initiated two of the indispensable preliminaries to sanitary progress: the Census, and a statistical survey of the country. In an autobiographical note detailing her relations with successive Viceroys, Miss Nightingale says that Lord Mayo's policy in sanitary and agricultural matters was in accord with lines which Sir Bartle Frere and she desired. "I say nothing," she adds, "of his splendid services in foreign policy, in his Feudatory States and Native Chiefs policy, in which doubtless Sir B. Frere helped him. I saw him more than once before he started, and he corresponded with me all the time of his too brief Viceroyalty. I think he was the most open man, except Sidney Herbert, I ever knew. I think it was Lord Stanley who said of him, 'He did things not from calculation, but from the nature of his mind.' Lord Mayo said himself that his Irish experience with 'a subject race' was so useful to him in India. He said that he was certainly the only Viceroy who had sold his own cattle in the market." "Florence the First, Empress of Scavengers, Queen of Nurses, Reverend Mother Superior of the British Army, Governess of the Governor of India" was Mr. Jowett's address when he heard of the interviews with Lord Mayo. "Empress of Scavengers" was M. Mohl's title for her at this time. "Rather," she said, "Maid of all (dirty) work; or, The Nuisances Removal Act: that's me." [104] For the former point, see the Annual Sanitary Reports; for a summary of the latter works, see Sir William Hunter's _Earl of Mayo_, pp. 177-8. Miss Nightingale's greatest ally in India at this time was, however, Lord Napier, Governor of Madras. "I remember Scutari," he wrote (June 24, 1868), "and I am one of the few original faithful left, and I think I am attached to you irrespective of sanitation." He was firm in her cause even where Sir John Lawrence had seemed unfaithful. The Governor-General had abandoned a scheme for female nursing (p. 157); Lord Napier carried one through in Madras, and corresponded at some length with Miss Nightingale on the subject. Sir John Lawrence had refused her advice to send some Engineer Officers home to study sanitary works; he had "none to spare." Lord Napier adopted the advice, and sent Captain H. Tulloch, whose visit to England and association with Mr. Rawlinson resulted in reports on urban drainage and the utilization of sewage. Lady Napier gave letters of introduction to Miss Nightingale to other officials from Madras, and Lord Napier reported progress to her constantly:-- (_Lord Napier to Miss Nightingale._) KODAIKANAL, _Sept._ 22 [1867]. I write to you from one of the Arsenals of Health in Southern India, from the Palni Hills, the most romantic and least visited of these salubrious and beautiful places.... I have deferred writing to you till I could announce that some sanitary good had really been secured worthy of your attention. I cannot say that such is yet the case, but something has been proposed and designed. We are building central jails to empty the district jails, and we are remodelling the district jails and rebuilding two or three. We are aerating and enlarging the lock-ups. I have stirred up the doctors in the general hospital at Madras. I have proposed to take the soldiers out of it and build them a new separate military Hospital (not yet sanctioned). I have endeavoured to raise the little native dispensaries and hospitals out of their sordid baseness and poverty. I am trying to get a new female hospital sanctioned for women, both European and native, with respectable diseases, and the others taken out and settled apart. I don't think my action has gone beyond a kind of impulse and movement. But we may effect something more important in the coming year. My wife has taken an active interest in the Magdalen Hospital, the Lying-in Hospital, and the orphanages of various kinds. We want money, zeal, belief; and knowledge in many quarters. (_Lord Napier to Miss Nightingale._) MADRAS, _Sept._ 3 [1868]. I am truly happy to find that I can do something to please you and that you will count me as a humble but devoted member of the Sanitary band, of _your_ band I might more properly say! Do you know that I was sent by Lord Stratford to salute and welcome you on your first arrival at Scutari and that I found you stretched on the sofa where I believe you never lay down again? I thought _then_ that it would be a great happiness to serve you, and if the Elchi would have given me to you I would have done so with all my heart and learned many things that would have been useful to me now. But the Elchi would never employ any one on serious work who was at all near himself, so I spent the best years of my life at a momentous crisis doing nothing when there was enough for all! But if I can do something now it will be a late compensation ... [report on various sanitary measures then in hand]. I have read the beautiful account of "Una" last evening driving along the melancholy shore. I send it to Lady Napier, who is in the Hills. I will write again soon, as you permit and even desire it, and I am ever your faithful, grateful and devoted Servant, NAPIER. (_Lord Napier to Miss Nightingale._) MADRAS, _June_ 3 [1869]. ... Now I have a good piece of news for you. We are framing a Bill for a general scheme of local taxation in this Presidency, both in municipalities and in villages, and the open country, to provide for three purposes--local roads, primary education, and Sanitation--such as improvement of wells, regulation of pilgrimages and fairs, drainage, &c. It will be very unpopular I fear in the first instance, for the people wish neither to be taught nor cured, but I think it is better on the whole to force their hands. We are driven to it, for I see clearly that we must wait a long time for help from the Supreme Government.... I was pleased and flattered to be mentioned by you in the same sentence with Lord Herbert. Indeed I am not worthy to tie the latchet of his shoe, but there are weaknesses and illusions which endure to the last, and I suppose I never shall be indifferent to see myself praised by a woman and placed in connection, however remote, with a person of so much virtue and distinction. You shall have the little labour that is left in me.[105] [105] The other day in a bookseller's catalogue of "Association Books" I found this item: "Florence Nightingale's _Notes on Lying-in Institutions_. Presentation copy, with autograph inscription, 'To His Excellency the Lord Napier, Madras, this little book, though on a most unsavoury subject, yet one which, entering into His Excellency's plans for the good of those under his enlightened rule, is not foreign to his thoughts--is offered by Florence Nightingale, London, Oct. 10, '71.'" A subject on which Miss Nightingale wrote both to Lord Napier and to Lord Mayo was the inquiry into cholera in India ordered by the Secretary of State in April 1869. She had made the proposition many months before. Indian medical officers were absorbed in propounding theories; Miss Nightingale wanted first an exhaustive inquiry into the facts. Even if such an inquiry did not establish any of the rival theories, it must lead, she thought, to much sanitary improvement. Sir Bartle Frere strongly supported the idea, and it was arranged that the War Office Sanitary Committee should make the suggestion and elaborate the scheme of procedure to be followed in India. The Committee meant for such a purpose Dr. Sutherland, and Dr. Sutherland meant in part Miss Nightingale. Sir Bartle Frere constantly wrote to her to know when the India Office might expect the Instructions, and Miss Nightingale as constantly applied the spur to Dr. Sutherland. On April 3 she delivered an ultimatum: "Unless the Cholera Instructions are sent to me to-day, I renounce work and go away." At last they arrived, and her friend received a withering note: "_April_ 13, 1869. I beg leave to remark that I found a letter of yours this morning dated early in Dec., which I mean to show you, in which, with the strongest objurgations of me, you told me that you could not come because you intended to get the Cholera Instructions through by _December_ 12, 1868. My dear soul, really Sir B. Frere could not have known the exhausting labour he has put you all to; to produce that in four months must prove fatal to all your constitutions! He is an ogre." Dr. Sutherland's Instructions are admirably exhaustive, and may well have taken some time to prepare. The remaining stages of the affair were quick, and the Secretary of State's dispatch went out to the Government of India on April 23, followed by private letters from Miss Nightingale. The Sanitary Blue-books of successive years contain copious reports and discussions upon this "Special Cholera Inquiry." It furnished much material for scientific discussion, by which Miss Nightingale sometimes feared that what she regarded as the essence of the matter was in danger of being overlaid. She and the Army Sanitary Committee took occasion more than once to point out that "whatever may be the origin of cholera, or whatever may ultimately be found to be its laws of movement, there is nothing in any of the papers except what strengthens the evidence for the intimate relation which all previous experience has shown to exist between the intensity and fatality of cholera in any locality and the sanitary condition of the population inhabiting it."[106] The origin of cholera is now said to be a micro-organism identified by Koch, but the laws of its movement and activity remain inscrutable. Meanwhile, all subsequent experience has confirmed the doctrine which Miss Nightingale continually preached, that the one protection against cholera consists in a standing condition of good sanitation. [106] Blue-book, 1870-71, p. 5; and see Bibliography A, No. 127. IV At the very time when Dr. Sutherland was hard at work upon the Cholera Instructions, Miss Nightingale heard a report (on good authority) which filled her with anger and consternation. Mr. Gladstone was engaged in cutting down the Army Estimates; the Army Medical Service was believed to be marked for retrenchment, and the War Office Sanitary Commission for destruction. When she told this to Dr. Sutherland, he took the matter with nonchalance and said (as men are sometimes apt to say in such cases, especially if there is a woman to rely upon) that he did not see that anything could be done. Very different was the view taken by Miss Nightingale, when she contemplated, not merely the interruption of Dr. Sutherland's useful work,[107] but the possibility of all Sidney Herbert's work being undermined. Nothing to be done indeed! There was everything to be done! She could write to the Prime Minister himself. She could write to Lord de Grey (Lord President). She could get this friend to approach one Minister, and that friend to approach another. She could even claim a slight acquaintance, and write to Mr. Cardwell (Secretary for War). She could write to all her friends among the Opposition and give them timely notice of the wicked things intended by their adversaries. She ultimately wrote to Lord de Grey, enclosing a letter which he was to hand or not, at his discretion, to Mr. Cardwell. The intervention was successful, and Lord de Grey asked her for Memoranda to "post him up" in the work of the Army Sanitary Commission and in the Sanitary Progress in India. Lord de Grey interceded with Mr. Cardwell also on behalf of the Army Medical School and it was spared. The Army Sanitary Committee was not touched, and for nearly twenty years more (till 1888) Dr. Sutherland continued his work upon it. Miss Nightingale's reports submitted to Lord de Grey are summarized in a letter to M. Mohl (Nov. 21, 1869):--"I am all in the arithmetical line now. Lately I have been making up our Returns in a popular form for one of the Cabinet Ministers (we are obliged to be very 'popular' for them--but hush! my abject respect for Cabinet Ministers prevails). I find that every year, taken upon the last four years for which we have returns (1864-7), there are, in the Home Army, 729 men alive every year who would have been dead but for Sidney Herbert's measures, and 5184 men always on active duty who would have been 'constantly sick' in bed. In India the difference is still more striking. Taken on the last two years, the death-rate of Bombay (civil, military and native) is lower than that of London, the healthiest city of Europe. And the death-rate of Calcutta is lower than that of Liverpool or Manchester![108] But this is not the greatest victory. The Municipal Commissioner of Bombay writes[109] that the 'huddled native masses clamorously invoke the aid of the Health Department' if but one death from cholera or small-pox occurs; whereas formerly half of them might be swept away and the other half think it all right. Now they attribute these deaths to dirty foul water and the like, and openly declare them preventable. No hope for future civilization among the 'masses' like this!" [107] Captain Galton took occasion in 1876 to render a tribute to Dr. Sutherland's services. "Possessed of high general culture, of remarkably acute perception, of a very wide experience, and of a perfectly balanced judgment, he has been the moving mind in the proceedings of the Army Sanitary Commission since its formation." (_Journal of the Society of Arts_, vol. xxiv. p. 520). [108] According to the Sanitary Blue-book for 1869-70, the death-rates per 1000 were: Bombay 19.2, London 23.3, Calcutta 31.9, Liverpool 36.4. In 1910 the order was very different: London 12.7, Liverpool 17.7, Calcutta 23.0, Bombay 35.7. In four years (1864-8) the death-rate in Bombay had fallen from 31.3 to 19.2; the rise in modern times is due to the industrialization of the town. [109] To Miss Nightingale; in the Blue-book (p. 186) it is similarly stated that "in three years the masses have begun to learn that such scourges as cholera, fever and the like can be prevented by the ordinary processes of sanitation." V In December 1869 Miss Nightingale made a new friend. Lord Napier of Magdala[110] was passing through London, and wrote to Sir Bartle Frere saying that it "would make him very happy if he could have the privilege of paying his respects to Miss Nightingale before he left." Sir Bartle begged Miss Nightingale to grant the favour, as Lord Napier was devoted to their cause and was likely to be employed in India again--as quickly came to pass, for in the following month he was appointed Commander-in-Chief.[111] Lord Napier called on December 14, in order (as he wrote to her in making the appointment) "to have an opportunity of saying how much I have felt indebted to you for the assistance that your precepts and example gave to all who have been concerned with the care of soldiers and their families." He spent some hours with her, and she was charmed with him. "I felt sure," wrote Sir Bartle Frere (Dec. 23), "that you would like Lord Napier of Magdala. He always seemed to me one of the few men fit for the Round Table." A long note which she recorded of the conversation shows how congenial it must have been to her, for Lord Napier talked with strong feeling of the importance and the practicability of improving the moral health of the British soldier. The administrators and the men of action always appealed to her more than the politicians, and Lord Napier of Magdala was now added to her list of heroes. "When I look at these three men (tho' strangely different[112])--Lord Lawrence, Lord Napier of Magdala and Sir Bartle Frere--for practical ability, for statesmanlike perception of where the truth lies and what is to be done and who is to do it, for high aim, for noble disinterestedness, I feel that there is not a Minister we have in England fit to tie their shoes--since Sidney Herbert. There is a simplicity, a largeness of view and character about these three men, as about Sidney Herbert, that does not exist in the present Ministers. They are party men; these three are statesmen. S. Herbert made enemies by not being a party man; it gave him such an advantage over them." Lord Napier of Magdala came to see Miss Nightingale again in the following year (March 18, 1870), spending in conversation with her his last hours before leaving London to take up his appointment in India. She and Sir Bartle Frere attached high importance to this interview. Lord Napier was a convinced sanitarian. He was bent upon introducing many reforms in the treatment of the soldiers. He believed in the possibility of improving both their moral and physical condition, by means of rational recreation and suitable employment. Sir Bartle Frere suggested to Miss Nightingale that after seeing the Commander-in-Chief she should write to the Viceroy so as to prepare his mind for what Lord Napier would propose. Lord Napier himself begged her to do so. "Everything in India," he said to her, "depends on what is thought in England, and it was you who raised public opinion in England on these subjects." Preparation of the Viceroy's mind was held to be the more necessary because a letter, lately received by Miss Nightingale from him, seemed to show that his sanitary education was by no means complete. So Mr. Jowett's "Governess of the Governors of India" took her pupil again by the hand, and, with Dr. Sutherland's assistance, drew up a further Memorandum on the Indian sanitary question at large. Referring him to the Royal Commission's Report, she pointed out that the causes of ill-health among the troops were many, and that there was no single panacea; that if other causes were not concurrently removed, the erection of new barracks could not suffice; that fever may lurk beneath and around "costly palaces" (for so Lord Mayo had called some of the new barracks) even as around hovels; that expense incurred in all-round sanitary improvement can never be costly in the sense of extravagant, because it is essentially saving and reproductive expenditure; and so forth, and so forth.[113] Miss Nightingale, before sending her letter, submitted it to Sir Bartle Frere (March 25). "I have nothing to suggest," he said, "in the way of alteration, and only wish that its words of wisdom were in print, and that thousands besides Lord Mayo could profit by them. They are in fact exactly what we want to have said to every one connected with the question from the Viceroy down to the Village Elder." Sir Bartle begged her to consider whether she could not write something to the same effect which would reach the latter class. Mr. Jowett had suggested something of the sort a few years before. "Did it ever occur to you," he had written (March 1867), "that you might write a short pamphlet or tract for the natives in India and get it translated? That would be a curious and interesting thing to do. When I saw the other day the account of Miss Carpenter in India, I felt half sorry that it was not you. They would have worshipped you like a divinity. A pretty reason! you will say. But then you might have gently rebuked the adoring natives as St. Paul did on a similar occasion, and assured them that you were only a Washerwoman and not a Divine at all; that would have had an excellent effect." Presently she found an opportunity of doing something in the kind that Mr. Jowett and Sir Bartle Frere had suggested. [110] Robert Cornelius Napier (1810-90), created Baron Napier of Magdala, 1868. Miss Nightingale's other friend, the Governor of Madras, Baron Napier (in the Scottish peerage), was created Baron Ettrick in the United Kingdom peerage, 1872. In first signing himself "Napier and Ettrick" in a letter to Miss Nightingale, he begged "the high priestess of irrigation" to observe that his new title was "watery." [111] In succession to Sir William Mansfield (Lord Sandhurst). On his return from India Lord Sandhurst came to see Miss Nightingale (July 8, 1870), and they corresponded afterwards. [112] Of Lord Lawrence and Sir Bartle Frere, Miss Nightingale wrote to Madame Mohl (March 26, 1869): "You can ask Sir Bartle Frere about Sir John Lawrence if you like. But they are so unlike, yet each so roundly perfect in his own way, that they can never understand each other--never touch at any point, not thro' eternity. I love and admire them both with all my mind and with all my heart, but have long since given up the slightest attempt to make either understand the other. But each is too much of a man, too noble, too chivalrous, to denigrate the other." [113] The substance of much of her Memorandum to Lord Mayo was embodied in the "Observations" which she contributed to the Indian Sanitary Blue-book, 1869-70; see especially p. 43. Meanwhile, Lord Mayo had introduced Dr. J. W. Cunningham to Miss Nightingale, and they became great allies. When he returned to resume his duties as "Sanitary Commissioner with the Government of India," he corresponded with Miss Nightingale regularly, telling her where things were backward and where a word in season from her would be helpful. In every question she took the keenest interest, sparing no pains to forward, so far as she could, every good scheme that was laid before her. In 1872 Mr. W. Clark, engineer to the municipality of Calcutta, came to see her about great schemes of water-supply and drainage. She obtained an introduction to Sir George Campbell, the Lieutenant-Governor of Bengal, in order to commend to his notice Mr. Clark's plans. For many years she was thus engaged in correspondence with sanitary reformers and officials in various parts of India, sending them words of encouragement when they seemed to desire and deserve it, words of advice when, as was frequently the case, they invited it. When such officials came home on furlough, most of them came also to Miss Nightingale. Dr. Sutherland, in his official capacity on the War Office Sanitary Committee, would often see them first; he would then pass them on to her, dividing them into two classes: those "whom you must simply lecture" and those "whose education you had better conduct by innocently putting searching questions to them." Miss Nightingale was never backward in filling the part of governess to those who in sanitary matters governed India. VI Sanitary improvement depended, however, on the governed as well as on the governors; and Miss Nightingale had for some time been extending her influence in India by making the personal acquaintance of Indian gentlemen. "I have been quite beset by Parsees," she wrote to M. Mohl (Feb. 16, 1868); "and after all I saw your Manochjee Cursetjee, that is, the 'Byron of the East.' Sir B. Frere says that few men have done so much for the education of their own race. He talked a good deal of Philosophy to me, while my head was entirely in Midwifery! He is (by his own proposal), if I can send out the Midwives, to take them in at the house of his daughters, of whom one married a Cama, and the other is the first Parsee lady who ever lived as an English single lady might do." Many other Indian ladies and gentlemen were introduced to Miss Nightingale personally or in correspondence by Miss Carpenter. In 1870 Miss Nightingale was elected an Honorary Member of the Bengal Social Science Association, the Council of which body was mainly composed of Indian gentlemen. She wrote a cordial letter of thanks (May 25). "For eleven years," she said, "what little I could do for India, for the conditions on which the Eternal has made to depend the lives and healths and social happiness of men, as well Native as European, has been the constant object of my thoughts by day and my thoughts by night." She eulogized the work that had been done by many private gentlemen of India; she put before them a vision of vast schemes of drainage and irrigation; she sent a subscription to the funds of the Association, and promised a contribution to its Proceedings. In this contribution,[114] sent in June 1870, Miss Nightingale did what Sir Bartle Frere desired: she addressed the Village Elder. "I think," said Dr. Sutherland, who had submitted a draft for Miss Nightingale to rewrite in her own language, "that this is the most important contribution you have made to the question." In simple and terse language, she described the sanitary reforms which might be carried out by the people themselves--pointing out in detail the nature of the evils, and the appropriate remedies for them, and then appealing to simple motives for sanitary improvement. "As we find in all history and true fable that the meanest causes universally multiplied produce the greatest effects, let us not think it other than a fitting sacrifice to the Eternal and Perfect One to look into the lowest habits of great peoples, in order, if we may, to awaken them to a sense of the injury they are doing themselves and the good they might do themselves. Much of the willingness for education is due to the fact, appreciated by them, that education makes money. But would not the same appreciation, if enlightened, show them that loss of health, loss of strength, loss of life, is loss of money, the greatest loss of money we know? And we may truly say that every sanitary improvement which saves health and life is worth its weight in gold." This address to the Peoples of India was the most widely distributed of all Miss Nightingale's missionary efforts. The Association translated it into Bengali. Sir Bartle Frere had it translated into other Indian languages. [114] Bibliography A, No. 56. VII Miss Nightingale's third sphere of missionary work was in the Sanitary Department at the India Office, to which, through her alliance with Sir Bartle Frere, she was a confidential adviser. Her action, in making suggestions and in seeking to influence officials in India, has been illustrated already. Her constant work was in helping to edit and in contributing to the Annual Blue-book containing reports of "measures adopted for sanitary improvements in India." The importance which Miss Nightingale attached to the publication of such an annual has been explained in general terms already (p. 145). She saw in it two useful purposes. First, the fact that reports from India were required and published each year acted as a spur to the authorities in that country; and, secondly, the introductory memorandum, and the inclusion of reports on Indian matters by the War Office Sanitary Committee, gave opportunity, year by year, for making suggestions and criticisms. The Annual was issued by the Sanitary Department at the India Office and edited by Mr. C. C. Plowden, a zealous clerk in that office with whom Miss Nightingale made friends; Sir Bartle Frere, as head of the Department, instructed him to submit all the reports to Miss Nightingale who in fact was assistant-editor, or perhaps rather (for her will seems to have been law) editor-in-chief. It was she who had prepared for the Royal Commission the analysis of sanitary defects in the several Indian Stations; who had written the "Observations" on them; who had taken a principal part in drafting the "Suggestions" for their reform. It was natural that she should be asked to report on the measures actually taken to that end. She was a very critical reporter. "Sir Bartle Frere hesitates a little," she was told on one occasion (1869), "as to the omission of all terms of praise, and says that the Indian Jupiter is a god of sunshine as well as thunder and should dispense both; he, however, sanctions the omission in the present case." Miss Nightingale's papers show that during the years 1869-74 she devoted great labour to the Annual. She read and criticised the abstracts of the local reports prepared by Mr. Plowden; she discussed all the points that they suggested with Dr. Sutherland; she wrote, or suggested, the introductory memorandum. She did this work with the greater zeal because it kept her informed of every detail; and the knowledge thus acquired gave the greater force to her private correspondence with Viceroys, Governors, Commanders-in-Chief, and Sanitary Commissioners. Her share in the first number of the Annual has been already described (p. 155). In the following year Mr. Plowden wrote (May 22, 1869): "I forward a sketch of the Introductory Memorandum to the Sanitary volume. You will see that the greater part of it is copied verbatim from a memorandum of your own that Sir Bartle Frere handed over to me for this purpose." "I can never thank you sufficiently," wrote Sir Bartle himself (July 5), "for all the kind help you have given to Mr. Plowden's Annual, at the cost of an amount of trouble to yourself which I hardly like to think of. But I feel sure it will leave its mark on India." She took good care that it should at any rate have a chance of doing so. She had discovered that the 1868 Report, though sent to India in October of that year, had not been distributed in the several Presidencies till June 1869. She now saw to it that copies of the 1869 Report were sent separately to the various stations by book-post. She continued to contribute in one way or another to successive volumes[115]; and that for 1874 included a long and important paper by her. [115] See Bibliography A, Nos. 57, 62. VIII Ten years before Miss Nightingale had popularized the Report of her Royal Commission in a paper entitled "How People may Live and Not Die in India." The Paper was read to the Social Science Congress in 1863. In 1873 she was again requested to contribute a Paper to the Congress. She chose for her title "How some People have Lived, and Not Died in India." It was a summary in popular form of ten years' progress, and this was the Paper which the India Office reprinted in its Blue-book of 1874. Miss Nightingale glanced in rapid detail at the improvements in various parts of India; took occasion to give credit to particularly zealous officials; and noticed incidentally some of the common objections. One objection was that caste prejudice must ever be an insuperable obstacle to sanitary improvement. She gave "a curious and cheerful" instance to the contrary. Calcutta had "found the fabled virtues of the Ganges in the pure water-tap." When the water-supply was first introduced, the high-caste Hindoos still desired their water-carriers to bring them the _sacred_ water from the _river_; but these functionaries, finding it much easier to take the water from the new taps, just rubbed in a little (vulgar, not sacred) mud and presented it as Ganges water. When at last the healthy fraud was discovered, public opinion, founded on experience, had already gone too far to return to dirty water. And the new water-supply was, at public meetings, adjudged to be "theologically as well as physically safe." Then there was the objection of expense, but she analysed the result of sanitary improvements in statistics of the army. The death-rate had been brought down from 69 per 1000 to 18. Only 18 men died where 69 died before. A sum of £285,000 was the money saving on recruits in a single year. The course of sanitary improvement, and the results of it, among the civil population cannot be brought to any such definite test; no Indian census was taken till 1872, registration of births and deaths was only beginning and was very imperfect; and India is a country as large as the whole of Europe (without Russia). It was the opinion of a competent authority that the sanitary progress which had been made in India during the years covered by Miss Nightingale's review "had no parallel in the history of the world";[116] but the progress was relative of course to the almost incredibly insanitary condition of the country when she began her crusade. The progress had been made along many different lines. First, in connection with the health of military stations, the Government of India established committees of military, civil, medical and engineering officers, of local magistrates and village authorities to regulate the sanitary arrangements of the neighbourhood. Sanitary oases for British troops were thus established in the midst of insanitary deserts. Then, sanitary regulations were issued for fairs and pilgrimages--each of these a focus of Indian disease. Institutions in India--hospitals, jails, asylums--had been greatly improved; and the municipalities of the great cities had made some sanitary progress. Ten years before, Miss Nightingale had reported to the Royal Commission that no one of the seats of Presidencies in India had as yet arrived at the degree of sanitary civilization shown in the worst parts of the worst English towns. Now, Calcutta had a pure-water supply and the main drainage of most of the town was complete. Bombay had done less by municipal action, but thanks to a specially vigorous Health Officer, Dr. Hewlett, sanitation had been improved. Madras had improved its water-supply and was successfully applying a part of its sewage to agriculture. The condition of the vast regions of rural India showed that the teaching of the Sanitary Commissioners was beginning to take some effect. Hollows and excavations near villages were being filled up; brushwood and jungle, removed; wells, cleaned. Surface refuse was being removed; and tanks were being provided for sewage, to prevent it going into the drinking-tanks. From reports of particular places, Miss Nightingale drew her favourite moral. There was a village in South India which had suffered very badly from cholera and fever. It was in a foul and wretched state, and had polluted water. Then wells were dug and properly protected; the surface drainage was improved; cleanliness was enforced; trees were planted. The village escaped the next visitation of the scourge. Miss Nightingale had many hours of depression, and many occasions of disappointment, as Health Missionary for India; but in her Paper of 1874 she bore "emphatic witness how great are the sanitary deeds already achieved, or in the course of being achieved, by the gallant Anglo-Indians, as formerly she bore emphatic witness against the then existing neglects." Only the fringe of the evil had been touched; but at any rate enough had been done to show that the old bogey, "the hopeless Indian climate," might in course of time be laid by wise precautions. "There is a vast work going on in India," said Dr. Sutherland; and in this work Miss Nightingale had throughout played a principal, and the inspiring, part. It was the opinion of an unprejudiced expert who, though he admired her devotion, did not always agree with her views or methods, that "of the sanitary improvements in India three-fourths are due to Miss Nightingale."[117] [116] Captain Galton, "On Sanitary Progress in India," 1876 (_Journal of the Society of Arts_, vol. xxiv. pp. 519-534.) This is the best _short_ account of the matter that I have come across. It is more detailed than Miss Nightingale's Paper of 1874. For further particulars, a reader should, of course, refer to the Annual Sanitary Blue-books. [117] So Sir Bartle Frere reported to Miss Nightingale that Sir John Strachey had said to him; and Sir John wrote in much the same sense to Miss Nightingale herself. But here, as in all things, her gaze was fixed upon the path to perfection. In her own mind she counted less the past advance than the future way. There was an Appendix to her Paper in which she preached the supreme importance of Irrigation--of irrigation, that is, combined with scientific drainage. Only by that means, she held, could yet more people "live and not die in India," and could the country be raised to its full productive power. A letter which Sir Stafford Northcote sent her (April 29, 1874), in acknowledgment of her Paper on "Life or Death in India," exactly expressed her own feelings. "How much," he said, "you have done! and how little you think you have done! After all, the measure of our work depends upon whether we take it by looking backwards or by looking forwards, by looking on what has been accomplished or on what has revealed itself as still to be accomplished. When we have got to the top of the mountain, are we much nearer the stars or not?"