The Life of Florence Nightingale Volume I Part 35

THE HOSPITAL REFORMER

(1858-1861)

It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle, because the actual mortality _in_ hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same cla.s.s of diseases among patients treated _out of_ hospitals would lead us to expect.--FLORENCE NIGHTINGALE (1863).

The work for the health of the soldiers, which has been described in the preceding Part, filled the larger part of Miss Nightingale's life during the five years after her return from the Crimean War; and in 1856, 1857, 1858 it occupied nearly the whole of her time. The work lasted for almost exactly five years, from the day of her return from Scutari (August 1856) to the day of Lord Herbert's death (August 1861). But into those strenuous years Miss Nightingale had crowded much other work besides. It has been necessary, for the sake of clearness and coherence, to treat the subject of Army sanitary reform consecutively in a single Part. In the present Part the other main occupations of Miss Nightingale's life during the same period, and more especially during the years 1859, 1860, and 1861, will be described.

The story of her life and work may be divided for convenience into separate Parts; but in her own mind each of the branches of effort into which successively she threw herself were connected parts of a larger whole. Her experiences in the Crimean War, and the emotions which grew out of them, had caused her to throw her first efforts into the cause of reform in the interest of her "children," the British soldiers. But all the time she saw with entire clearness that the health of the Army was only part of a larger question; namely, the health of the whole population from which the soldiers are drawn. She had made her reputation by work in military hospitals, and her first effort was to improve them, but she saw that the condition of civil hospitals was the larger and the more important matter. And she saw further still that hospitals are at best only a necessary evil; a necessity, as some one has said, in an intermediate stage of civilization. The secret of national health is to be found in the homes of the people. If in a particular town or quarter, for instance, there was excessive infant mortality, the remedy, as she said, was not to be found in building more children's hospitals there. She was famous throughout the world as a war-nurse; but she knew that the difficulties which she had encountered in that sphere were due to the fact that the art of nursing was so ill understood at home. Her vision took wider scope, and her efforts to improve the well-being of the people embraced, as we shall hear, both India and the Colonies. Mr. Disraeli, in a famous speech[302] delivered the saying _Sanitas sanitatum, omnia Sanitas_, but that was in 1864; it was Miss Nightingale's motto many years before. When the extent of her range and the depth of her influence are considered, the claim made for her by an American writer will not seem exaggerated: she was "the foremost sanitarian of her age."[303] Our immediate concern is with her life and work, first, as a Hospital Reformer (Chaps. I., II.), and then as the founder of Modern Nursing (Chaps. III., IV.).

[302] At Aylesbury, Sept. 21, 1864.

[303] _Nutting_, vol. ii. pp. 207-8.

Miss Nightingale's authority on the subject of Hospitals ruled paramount in the years following the Crimean War--as the reference of the Netley plans to her has already indicated. Popularity and prestige were confirmed by a practical experience which at the time was probably unique. "Have you," she was asked by the Royal Commission of 1857, "devoted attention to the organization of civil and military hospitals?"

"Yes," she replied, "for thirteen years. I have visited all the hospitals in London, Dublin, and Edinburgh, many county hospitals, some of the naval and military hospitals in England; all the hospitals in Paris, and studied with the 's[oe]urs de charite'; the Inst.i.tution of Protestant Deaconesses at Kaiserswerth, on the Rhine, where I was twice in training as a nurse; the hospitals at Berlin, and many others in Germany, at Lyons, Rome, Alexandria, Constantinople, Brussels; also the war hospitals of the French and Sardinians." Her authority on the subject was strengthened yet more when her Papers, already mentioned,[304] which were read at Liverpool in October 1858, were, early in the following year, published, with additional matter, as a book. "It appears to me," wrote Sir James Paget, in acknowledging a copy of the book, _Notes on Hospitals_, "to be the most valuable contribution to sanitary science in application to medical inst.i.tutions that I have ever read." The book has not been reprinted since 1863, and is now, perhaps, forgotten; but, if so, that is the necessary fate of many a notable book. The pioneers of one generation are forgotten when their work has pa.s.sed into the accepted doctrine and practice of another. In its day Miss Nightingale's _Notes on Hospitals_ revolutionized many ideas, and gave a new direction to hospital construction.

[304] Above, p. 383.

Sir James Paget's words accurately suggest the nature of Miss Nightingale's work in this field. Before she wrote, there was sad need of the application of sanitary science to many of our hospitals. The rate of mortality in them was terribly high. Hospitals created almost as many diseases as they cured; there was hospital gangrene, hospital pyaemia, hospital erysipelas, hospital fever, and so forth. It was even questioned whether great hospitals were not, and must not necessarily be, producers of disease. Miss Nightingale showed that there was no such necessity. By the light of sanitary science, she traced back the excessive mortality in hospitals to its true causes, in original defects in the site, in the agglomeration of a large number of sick under the same roof, in deficiency of s.p.a.ce, deficiency of ventilation, deficiency of light. In a second section of her book, going more into detail, she enumerated "Sixteen Sanitary Defects in the Construction of Hospital Wards," adding to the statement of each defect precise suggestions of a remedy. She added a series of equally detailed hints on hospital construction, ill.u.s.trating them by careful plans, exterior and interior, of some of the best modern hospitals and of the worst old ones. Some of my readers may be acquainted only with modern hospitals, and it will be well perhaps to describe the defects in the old style of hospital. Many of the hospitals and infirmaries, as they existed when Miss Nightingale started her crusade, had been built with no consideration for the sub-soil, and the drainage of them was very imperfect. The wards were sadly overcrowded, often as much as three or four times over, tried by the present standard of the number of cubic feet desirable per bed.

Ventilation was defective. The wards were often low. There were frequently more than two beds between the windows. Little attention had been given to the supreme importance of having floors, walls, and ceilings which were non-absorbent. The furniture of the wards, and the utensils, were such as would be condemned to-day as hopelessly insanitary. Miss Nightingale found it necessary to enter in some detail upon the desirability of _iron_ bedsteads, _hair_ mattresses, and _gla.s.s_ or _earthenware_ cups, etc. (instead of tin); as also upon that of sanitary forethought in the construction of sinks and other places.

Hospital kitchens and laundries at home were not quite so bad as at Scutari; but many of the kitchens were still very primitive, and many of the laundries inspected by Miss Nightingale were "small, dark, wet, unventilated, overcrowded, so full of steam loaded with organic matter that it is hardly possible to see across the room." All this is now, for the most part, a thing of the past; and the pa.s.sing of it is due, in large measure, to Miss Nightingale. Coinciding, as her book did, with a movement for increased hospital accommodation, and coming with the prestige of a popular heroine, her _Notes on Hospitals_ opened a new era in hospital reform. There had, it is true, been improvement before her time; and she was not the one and only discoverer of the simple principles which she enunciated, and which are now the A B C of the subject. But the general level of thought or practice does not always rise to the height of the better opinion; it depends too often upon the average opinion of the day. Moreover, in some matters, there was, at the time when she wrote, a conflict of principles, in which the victory was generally given to the wrong side. The beneficial effect of fresh air was not always denied; but the advantage of securing warmth by shutting the windows, and relying upon artificial methods of ventilation, was in practice considered paramount. Miss Nightingale was a pioneer in the consistent emphasis which she gave to the supreme necessity of fresh air, and to the importance of "direct sunlight, not only daylight, except perhaps in certain ophthalmic and a small number of other cases."

She based her contention in these matters on scientific principles; she supported it from her experience and observation in the Crimean War and in foreign hospitals. In many quarters her ideas were new and revolutionary. We have heard already what "a bitter pill" it was to one eminent medical official of her day to swallow the idea of "pavilions"

in hospital construction.[305] Lord Palmerston explained in the House of Commons in 1858 that, "strange as it might appear, considering the progress of science in every department, it was only within a few years that mankind has found out that oxygen and pure air were conducive to the well-being of the body."[306] And in the matter of the curative effect of light, Miss Nightingale cited from an official publication the case of a well-known London physician, who "whenever he enters a sick-room, takes care that the bed shall be turned away from the light."

"An acquaintance of ours," she added, "pa.s.sing a barrack one day, saw the windows on the sunny side boarded up in a fas.h.i.+on peculiar to prisons and penitentiaries. He said to a friend who accompanied him, 'I was not aware that you had a penitentiary in this neighbourhood.' 'Oh,'

said he, 'it is not a penitentiary, it is a military hospital.'"[307]

Miss Nightingale's general principles commanded the hearty support of the better medical opinion, and to many medical men her details, drawn from observation in the best foreign hospitals, afforded new and useful hints; while at the same time she commanded in a singular degree the ear of the general public, including town councillors, guardians, and benevolent persons. It was in this way that her book did so much to improve the level of hospital construction and hospital arrangement in this country.

[305] Above, p. 342.

[306] Speech on Lord Ebrington's Resolutions, May 11, 1858.

[307] _Notes on Hospitals_, 1859, pp. 100, 108.

Upon the construction of military hospitals--whether general or attached to particular barracks--Miss Nightingale was consulted constantly and as a matter of course. In 1859, it will be remembered, Mr. Herbert became Secretary for War; and in 1860 Captain Galton was appointed temporary a.s.sistant inspector-general of "Fortifications"--a department which included works for barracks and hospitals. She respected Captain Galton's abilities, and liked him personally very much. He and Mr.

Herbert took her advice upon all works within her province, and the plans of the new General Hospital at Woolwich in particular owed much to her suggestive ingenuity. She even drew up the heads of the specifications for it. Even where she was not directly consulted or concerned, her influence and the standard she had set up in her book had an effect. Medical officers and military governors sought leave to be able to quote her approval of hospitals under their charge. It would, as one navely wrote to her, improve their chances of promotion.

A more direct result of the publication of _Notes on Hospitals_ was to bring in upon Miss Nightingale copious requests for advice from the committees or officials of civic hospitals and infirmaries throughout the country. To all such requests she readily responded. Writing was with her a means to action; and when she was given any chance of translating "Notes" into deeds, no trouble was too great for her. She had decided views of her own, but in particular cases she often consulted other experts. Dr. Sutherland, one of the leading authorities in such matters, was, as we have seen, constantly with her. To her kinsman by marriage, Captain Galton, she frequently referred; and she sometimes engaged Sir Robert Rawlinson professionally to prepare plans and specifications for her to submit to those who asked her advice. He on his part often consulted her in regard to hospitals and infirmaries on which he had been called in to advise. Her advice was sought both by those who were actually projecting new hospital buildings and by those who were leading crusades for the reconstruction of their local inst.i.tutions. Among her papers there is a ma.s.s of correspondence, specifications, plans, memoranda of all sorts, referring to such matters. Technical details are often relieved by touches of Miss Nightingale's humour. Here are two examples from her letters to Captain Galton--(March 24, 1861): "I understand that Baring[308] won't ventilate the Barracks in summer because the grates are not hot enough in winter.

Why are the men to die of foul air in August because they are too cold at Christmas? I think Baring must be an army doctor." (June 20, 1861): "Is the Architect's ideal the profile of a revolver pistol? If you look at the block plan in this point of view, it is very good. But as he asks my opinion, it is that I would much rather be shot outside than in. As Hospital principles are beginning to be well known, it would be quite enough to engrave this plan on the card of solicitation to stop all subscriptions. No patient will ever get well there. And as I don't approve of the principle of Lock Hospitals, I had much better let it go on." The correspondence about hospital plans ranges in place and scale from Glasgow, from which city she was asked to advise upon cement for the walls of the Infirmary wards, to Lisbon, where a new inst.i.tution was to be built according to her ideas. In 1859 the King of Portugal asked Miss Nightingale through the Prince Consort to advise and report upon the plans for a hospital which he desired to build in memory of his wife, the Princess Stephanie of Hohenzollern. This affair occupied some of her attention during two years, and caused her not a little impatience. With Dr. Sutherland's help, she went laboriously through the plans submitted by the King's architect on the a.s.sumption that the hospital was intended for adults. It then appeared that what the King wanted was a Children's Hospital. The Prince Consort, through Colonel Phipps, was deeply grieved at "the waste of Miss Nightingale's time and of her strength, so precious." Dom Pedro V., taking an easier view, did not see that it mattered. A hospital, constructed for adults, but intended for children, would, His Majesty pleasantly suggested, "only give the children more room and more air." The King had to be given a lesson in the niceties of hospital construction. The architect and Miss Nightingale set to work again on amended plans. Her suggestions were warmly approved, on the Prince Consort's behalf, by Sir James Clark, and Dom Pedro sent her a cordial letter of thanks.

[308] Under-Secretary for War, when Mr. Herbert was made a Peer.

At home she took similar pains with plans for the Bucks County Infirmary at Aylesbury; but here it was easier sailing, for the chairman of the Committee was her brother-in-law, Sir Harry Verney, and it was promptly decided (1860) to rebuild the Infirmary "in accordance with the requirements specified in Miss Nightingale's _Notes on Hospitals_." In another county hospital, that at Winchester, she took the more interest, because one of her father's properties (Embley) was in the county. There is a specially voluminous correspondence on the subject, largely with Sir William Heathcote (chairman of the Governors),[309] extending over several years. The old hospital was admittedly bad, but the first idea was to patch it up. Miss Nightingale took infinite pains in working up the case against this course. She studied the report which Sir Robert Rawlinson, the sanitary engineer, had sent in; and she tabulated the statistics of mortality, comparing them with those of well-appointed hospitals on healthy sites. Thus armed, she told the Committee roundly that they were proposing to sink money in patching up a "pest-house, where a number of people are exposed to the risk of fatal illness from a special hospital disease." Was Hamps.h.i.+re eager, she asked, to emulate the evil fame of Scutari? Then she tackled the financial problem. She compared the estimated cost of "adaptation" with that of building a new hospital on a better site. She submitted plans and details of her estimate. She promised the advice of Dr. Sutherland in the choice of a new site. "I understand," she wrote, "that Lord Ashburton will give 1000 towards a new hospital, if built upon a new site; if not, nothing." As Lady Ashburton was one of her dearest friends, this condition was probably not unprompted. On the same condition, she promised contributions from herself and her father. She collected and sent in the opinions of eminent experts--civil engineers and medical officers--on the question. She prodded friends possessing local influence: "Would you please," she wrote to Captain Galton (Feb. 10, 1861), "devote the first day of every week until further notice in driving nails into Jack Bonham Carter,[310] M.P., about the Winchester Infirmary?" In the end she carried her point, and a new hospital was built by Mr. b.u.t.terfield on a higher and healthier site. "It is the greatest pleasure," the architect wrote to her (Dec. 1863), "to try and work out the views of one who is ably and earnestly endeavouring to make a reformation." Among other inst.i.tutions upon which she advised, in this (1860) or immediately ensuing years, were the Birkenhead Hospital, the Chorlton Union Infirmary, the Coventry Hospital, the Guildford (Surrey County) Hospital, the Leeds Infirmary, the Malta (Incurables) Hospital, the Putney Royal Hospital for Incurables, the North Staffords.h.i.+re Infirmary, and the Swansea Infirmary. Correspondence from foreign countries, and a collection of tracts upon Hospital Construction (1863) sent to her from France and Belgium, show that the "reformation" was widespread. In India also her book was found useful. "It arrived in the nick of time," wrote Sir Charles Trevelyan, the Governor of Madras (Aug.

10, 1859), "as you will see by the accompanying note from Major Horsley, the engineer entrusted with the preparation of the plan of the addition to our General Hospital."

[309] Mr. Nightingale bought Embley from the Heathcote family.

[310] Eldest son of the John Bonham Carter mentioned above (p. 29); M.P.

for Winchester; first cousin of Miss Nightingale and of Mrs.

Galton.

II

Like other reformers, Miss Nightingale encountered an occasional defeat.

One was at Manchester in a cause wherein she was enlisted by a friend of Cobden, Mr. Joseph Adshead. He saw something of Miss Nightingale during these years, and corresponded voluminously with her. He is the subject of one of her clever and vivid character-sketches--a sketch which throws interesting side-lights on her own character too:--

(_Miss Nightingale to Samuel Smith._) BURLINGTON, _Feb._ 25, [1861]. DEAR UNCLE SAM--Adshead of Manchester is dead--my best pupil.... How often I have called him my "dear old Addle-head," and now he is dead. He was a man who could hardly write or speak the Queen's English; I believe he raised himself, and was now a kind of manufacturer's agent in Manchester. He was a man of very ordinary abilities and commonplace appearance--vulgar, but never unbusiness-like, which is, I think, the worst kind of vulgarity.

Having made "a competency," he did not give up business, but devoted himself to good works for Manchester. And there is scarcely a good thing in Manchester, of which he has not been the main-stay or the source--schools, infirmary, paving and draining, water-supply, etc., etc. At 60, he takes up an entirely new subject, Hospital Construction, fired by my book, and determines to master it.

This is what I think is peculiarly Anglo-Saxon. He writes to me whether I will teach him (this is about 18 months ago), and composes some plans for a Convalescent Hospital _out of_ Manchester, to become their main Hospital if the wind is favourable. He comes up to London to see me about these. The working plans pa.s.sed eight times thro' my hands and gave me more trouble than anything I ever did. Because Adshead would not employ a proper builder, but would do them himself-- which is part of the same character, I believe. The plans are now quite ready, but nothing more. He meant to _beg in person_ all over Lancas.h.i.+re, and had already some promises of large sums. He had been asking for about a year, but never intermitted anything. I don't know whether you remember that I had a three-months' correspondence with him (and oh! the immense trouble he took) about the transplantation of the Spitalfields and Coventry weavers to Manchester, Preston, Burnley, etc.[311] ... It never came to anything.... He was 61 when he died. This is the character which I believe is quite peculiar to our race--a man, a common tradesman, who--instead of "retiring from the world" to "make his salvation," or giving himself up to science or to his family in his old age, or founding an Order, or building a housewill patiently (at 60) learn new dodges and new-fangled ideas in order to benefit his native city.... How I do feel that it is the strength of our country and worth all the R. Catholic "Orders" put together. I hate an "Order," and am so glad I was never "let in" to form one....

[311] Miss Sellon had called her attention to the sad plight through unemployment of the Spitalfields weavers, as had Mr. and Mrs.

Bracebridge to that of those at Coventry. Miss Nightingale, with help from Mr. Bracebridge, enlisted Mr. Adshead in a scheme for migrating them to Lancas.h.i.+re. He and she took infinite pains in the matter, but the scheme came to little. When it reached the point, Miss Sellon's friends were not ready to go.

Mr. Adshead had taken a prominent part in a movement to get the Manchester Royal Infirmary condemned as insanitary, and to rebuild it in better air outside the city boundaries. Miss Nightingale, though she did not join publicly in the controversy, plied Mr. Adshead with powder and shot. But they were defeated. Manchester decided to patch and not to rebuild.

In the case of St. Thomas's Hospital in London, which was confronted from a different cause with the same choice, she was successful.

Hospital officials, when in difficulty, not infrequently "went to Miss Nightingale." This was the case with Mr. Whitfield, the Resident Medical Officer of St. Thomas's (then on its ancient site in the Borough), when the future of the Hospital was threatened by the projected extension of the South-Eastern Railway from London Bridge to Charing Cross. The Railway Company sought powers to take some of the Hospital's land, and the opinion of the Governors was likely to be divided on the policy to be pursued. Mr. Whitfield was from the first in favour of the course which ultimately prevailed; the Railway Company should be compelled to buy all the Hospital's land or none, and in the former event the Hospital should be rebuilt on a healthier site and on an improved plan.

But there were others who were disposed to take the line of least resistance, and to be content with rebuilding on the old or an adjacent site so much as the railway works made necessary. Mr. Whitfield opened the case to Miss Nightingale in February 1859, and besought her aid; she entirely agreed with him, and threw herself whole-heartedly into the matter. Among the Governors of the Hospital was the Prince Consort, to whom she sent a careful memorandum. The Prince went into the case with his usual thoroughness, and ultimately concurred in Miss Nightingale's views. He was scrupulous, as the correspondence shows, to avoid any interference with the parliamentary side of the case, but he let it be known, among his colleagues on the Board of Governors, what his opinion was upon the best policy for the Hospital to pursue, in the event of Parliament leaving it any option. "Your intervention with Prince Albert," wrote Mr. Whitfield presently to Miss Nightingale, "has wrought wonders." But there were still two opinions. There was a strong party which attached more importance to retaining the Hospital on its old site, "in the midst of the people whom it served," than to removing it to one which might be more salubrious, but must be more distant. This is a controversy which continually recurs. Miss Nightingale took immense pains in working up the case for removal. She resorted, as usual, to a statistical method. She a.n.a.lysed the place of origin of all the cases received; tabulated the percentages in various radii; and showed that the removal of the hospital to such and such distances would affect a far smaller percentage of patients than was commonly supposed. Then she made out sums in proportion, setting, on the one side, so much inconvenience and conceivable danger in making a smaller number of patients take a little longer time in reaching the Hospital; and, on the other, the greater convenience and larger chance of recovery which all the patients alike would have in better surroundings. At the end of 1860 the critical moment arrived. The Railway Company had served the Hospital with notice to decide within twenty-one days. Mr. Whitfield wrote to Miss Nightingale in a state of considerable flurry. He was by no means certain how the voting would go; every vote and every influence were important; could she not whisper once more in the Prince Consort's ear?

She wrote to the Palace forthwith; and the Prince communicated his views to the Court of Governors on her side. And not only on her side. "You will find in the Prince's letter," she was told by one of those behind the scenes, "your own arguments and sometimes even your own words embodied." Ultimately the Governors decided as Miss Nightingale wished.

The Railway Company was required to take all or none of the Hospital's land. It took all and, as usually happens in railway cases, the price was not suffered to err on the side of moderation. St. Thomas's Hospital was removed to temporary buildings on the old Surrey Gardens, and there remained till the present Hospital was completed in 1871.

A fair American visitor, taking tea upon the terrace of the Houses of Parliament, and looking across the river to the sevenfold splendours opposite, is said to have inquired, "Are those the mansions of your aristocracy?" They are only instances of the reform which Miss Nightingale introduced in Hospital construction, being the "pavilions"

of St. Thomas's. But Miss Nightingale was never consulted, I feel sure, upon the architectural ornament of the parapets. Her sense of humour would have made short work of the urns which, as some one has suggested, seem waiting for the ashes of the patients inside.

CHAPTER II

THE Pa.s.sIONATE STATISTICIAN

(1859-1861)

Full and minute statistical details are to the lawgiver, as the chart, the compa.s.s, and the lead to the navigator.--LORD BROUGHAM.

I remember hearing the first Lord Goschen make a speech in Whitechapel many years ago, in which he avowed that for his part he was "a pa.s.sionate statistician." "Go with me," he said, "into the study of statistics, and I will make you all enthusiasts in statistics." Mr.

_Punch_ parodied Marlowe thereupon, and invited his readers to "all the pleasures prove That facts and figures can supply Unto the Statist's ravished eye." I do not know whether any large response to the invitation was forthcoming from Lord Goschen's hearers or Mr. _Punch's_ readers; though, since the day when Lord Goschen spoke, social reformers have more and more guided their schemes by the chart and compa.s.s of statistics. If Miss Nightingale saw the speech, it fell upon eyes long ago opened. A fondness for statistical method, a belief in its almost illimitable efficacy, was one of her marked characteristics.

Few books made a greater impression on Miss Nightingale than those of Adolphe Quetelet, the Belgian astronomer, meteorologist, and statistician; and she had few friends whom she valued more highly than Dr. William Farr, the leading statistician of her day in this country.

From his meteorological studies, Quetelet deduced a law of the flowering of plants. One of his cases was the lilac. The common lilac flowers, according to Quetelet's law, when the sum of the squares of the mean daily temperatures, counted from the end of the frosts, equals 4264 _centigrade_. Miss Nightingale was greatly interested in such calculations, and the lilac had a special place in her year. Lady Verney's birthday was April 19, and a branch of flowering lilac was Florence's regular birthday present to her sister. Miss Nightingale used to talk of Quetelet's law with great delight, and commended it to gardening friends for verification in their Naturalist's Diaries. But this is a lighter example of Quetelet's researches. What fascinated Miss Nightingale most was his _Essai de physique sociale_ (first published in 1835), in which he showed the possibility of applying the statistical method to social dynamics, and deduced from such method various conclusions with regard to the physical and intellectual qualities of man. In regard to sanitation, we have heard already of the reforms which Miss Nightingale was instrumental in carrying out in Army Medical Statistics. She turned next to the question of Hospital Statistics, where improvement seemed desirable both for the surer advance of medical knowledge and in the interests of good administration.

Miss Nightingale had been painfully impressed during the Crimean War with the statistical carelessness which prevailed in the military hospitals. Even the number of deaths was not accurately recorded. "At Scutari," she said, "three separate registers were kept. First, the Adjutant's daily Head-roll of soldiers' burials, on which it may be presumed no one was entered who was not buried, although it is possible that some may have been buried who were not entered. Second, the Medical Officers' Return, in regard to which it is quite certain that hundreds of men were buried who never appeared upon it. Third, the return made in the Orderly Room, which is only remarkable as giving a totally different account of the deaths from either of the others."[312] When Miss Nightingale came home, and began examining Hospital Statistics in London, she found, not indeed such glaring carelessness as this, but a complete lack of scientific co-ordination. The statistics of hospitals were kept on no uniform plan. Each hospital followed its own nomenclature and cla.s.sification of diseases. There had been no reduction on any uniform model of the vast amount of observations which had been made. "So far as relates," she said, "either to medical or to sanitary science, these observations in their present state bear exactly the same relation as an indefinite number of astronomical observations made without concert, and reduced to no common standard, would bear to the progress of astronomy."[313]