GIFT OF CxO ^ MEDICAL SEMINAR DISCUSSIONS EDNA LOCKE MEDICAL SEMINAR DISCUSSIONS BY Edna Locke "In as much as this world is, after all, absolutely governed by ideas, and very often by the wildest and most hypothetical ideas, it is a matter of the very greatest importance that our theories of things, and even of things that seem a long way apart from our daily lives, should be as far as possible true, and as far as possible removed from error." Huxley. Copyright by Edna Locke 1912 MEDICAL SEMINAR DISCUSSIONS HAHNEMANN * MEDICINE viewed from a scientific stand- point does not permit the consideration of Hahnemann, for of all the exponents of medicine, who have- contentedly reposed on conjecture, Hahnemann was pre-eminently the star guesser. When his ideas were dis- countenanced by the medical profession, he did not hesitate to place his case before the public at large as a court of appeal. This brought about a popular controversy, which not only contributed largely to the success * Read at the Medical Seminar, University of California, February 28, 1912 3 255954 MEDICAL SEMINAR DISCUSSIONS of his system but stimulated in the lay mind the belief in its right of judgment in matters highly technical and scientific. Hahnemarin with his clairvoyant mind required no knowl- edge of the cause and nature of disease. He ignored every suggestion of pathology; he found symptoms much more convenient to contend with, and the task of selecting reme- dies was greatly simplified by using only symptoms as a working base. Furthermore this process was comparatively easy to ex- plain to the public for its valuable indorse- ment. And was not popular indorsement the main support of medicine? It was for his kind of medicine. Though public opinion is always to be reckoned with, its favorable verdict seems to be especially sought after by a certain class of purveyors of things medical. Did Hahnemann really believe in his ridiculous medication? Was he a religious fanatic gone astray in the field of medicine ? 4 HAHNEMANN Or was he so bewildered with disappoint- ment in drugs that he practically abandoned their use, yet gave them the charm of mystery to appease the lay mind ? On the other hand, did Hahnemann not accomplish some good? Was he not of service to humanity? When we consider the heroic measures used in medicine in the latter part of the eighteenth century, for instance, the enormous dosage from two to three ounces of saltpetre in a single day was not moderation devoutly to be wished? The influence of Samuel Hahnemann helped to moderate this excess- ive dosage. Hahnemann was born in Meissen, Ger- many, 1755, and died in Paris, 1843. In 1796, he brought forth his peculiar system of medicine, which in a way was a natural reaction against the drastic measures then prevalent, but in the rebound he practically reached medical nihilism. He also advanced theories which denied disease, admitting only 5 MEDICAL SEMINAR DISCUSSIONS symptoms. The halls of the United States Senate recently echoed a voice that surpassed Hahnemann by denying both disease and symptoms. For this sparkling absurdity we have to thank a senator from California, who is a sponsor for Christian Science. While Hahnemann made no contribution to scientific medicine, his errors were such as to counteract the more dangerous errors of others. This, indeed, was an instance of "likes cured by likes." Hahnemann not only selected and pre- pared his drugs by a strange mingling of ingenuity and false reasoning but he also gave them a spritual attribute. The salient requisite in the preparation of a drug was an extraordinary attenuation. He gave minute directions for achieving this extreme atten- uation by long continued trituration, suc- cussion, and dilution ; after which we are not surprised that the drug required spiritual aid. He ordered the original tinctures to be 6 HAHNEMANK reduced in strength to one-fiftieth, and these dilutions again reduced to one-fiftieth, and the next dilutions again reduced to one- fiftieth, and so on to the thirtieth dilution, which he himself used by preference. So carried away was he with this idea that he claimed he could scarcely name one disease that was not most successfully treated by merely smelling the medicine, and the results were equally gratifying even when the patient was destitute of the sense of smell. That medicine gained strength by this ex- treme attenuation, he declared, "was estab- lished beyond the reach of cavil from future experience, either of the allopaths or of practitioners of the new mongrel system made up of a mixture of allopathic and homeopathic processes." This reference to a mongrel system was a wild flower dropped on the brow of the Eclectic. With Hahnemann pain on the right side of the head indicated a certain drug, while 7 MEDICAL SEMINAR DISCUSSIONS pain on the left side of the head indicated an entirely different drug. His discrimina- tion of both symptoms and drugs was exquis- ite. Francis Bacon said, "Variety of medi- cines is the child of ignorance." We must not assume, however, that Hahnemann ad- vocated different medicines for what he con- sidered the same symptom. One of his most vehement injunctions was, "One drug at. a time." The attenuation made certain its one merit of doing no harm; and if so desired it could be changed for another drug, which for a like reason could again be changed, and so on. But Hahnemann exhorted his fol- lowers to stick to one drug, not to change the treatment. He probably knew that any one tincture of his thirtieth dilution was no better than any other, and he possibly anticipated the awkward discov-^ ery that his remedies might be inter- changed without altering the result. Hahne- mann's medication had the excellent virtue 8 HAHNEMANN that if it did no good it would do no harm> This idea of a medicine being harmless has always been a talking point for popular indorsement, and we must class the Hahne- mann system with other schools of fad and fancy depending wholly upon popular in- dorsement. These schools will be briefly referred to in this discussion. Let us recall that the term "Medicine" refers not only to a substance used as a remedy or palliative in disease, but in its full definition medicine includes every avail- able means for preserving or restoring the health and comfort of the animal organism. Thus hygiene, dietetics, manipulation of muscles and joints, heat, cold, moisture, and mental influence are within the term medi- cine. This freedom of method has resulted in the various so-called schools of medicine. In the past this freedom of method more often meant lack of method or in reality a blind groping, though it contributed some 9 MEDICAL SEMINAR DISCUSSIONS useful discoveries, which are among the empirical remedies still in use. The tendency has always been a too ready assumption of a curative value, instead of a conservative acceptance based on a closer study of both the disease and the remedy. We know there have been exceptions to this tendency. Ages before the existence of chemical analysis, of the thermometer, the stethoscope, the micro- scope, and other instruments of precision, many diseases were described by Hippo- crates, and so accurately described, with the treatment so logical, as to startle the savant of to-day. With this early start of extraor- dinary genius, how do we account for the succeeding centuries of error tinged with charlatanism? It is this: The study of medicine consists essentially of two depart- ments diagnosis and treatment. Diagno- sis is the study of the cause and nature of the disease; treatment the application of remedies. The great students of all times 10 HAHNEMANN have paid especial attention to diagnosis, recognizing it as the necessary forerunner and guide to proper treatment ; but the pub- lic at large is little interested in the real nature of disease. The man knows he is sick, and he wants to get well. He is inter- ested only in treatment. "Treatment" is the popular demand, and popular demand is the field for the charlatan. Suffering humanity is prone to give an eager ear to the glittering promise of the pretender rather than to the sober fact of the serious scholar. Often has the dignified and sacred func- tion of medicine been lowered to support the most stupid claims and fantastical imagin- ings. Throughout history we read not only of remedies absolutely inert, as those of Hahnemann, but also of those which are gro- tesque and ludicrous; for instance "The moss, that groweth on the skull of a dead man, is good for staunching blood; and the sting of a yello\v- jacket is best cured by 11 MEDICAL SEMINAR DISCUSSIONS rubbing on the fresh brains of a coyote." The instructions for applying the latter remedy are disappointing as there are no directions for obtaining the fresh brains of that particular animal, though it has been observed that the sting of a robust yellow- jacket might instill enough speed into the patient to enable him to catch his own coy- ote. Thus for ages has the pendulum of medical art swung from the sublime to the ridiculous. In the distant past, the mind was be- fogged in mystery and the spirit crushed by repeated error. Eventually a time came when the knowledge of physiology and anat- omy was less perilously gained. Before that time the art of medicine had been closely in- termingled with philosophy and religion, and it had been taught that the dissection of the dead body was wrong and even impious. This idea was so firmly rooted that for cen- turies such prohibition was maintained by 12 HAHNEMANN civil law. Yet strangely enough the author- ities by way of punishment had little hesi- tancy in submitting the living body to cruel mutilation. In this crude past the cradle of science was dangerously rocked. En- deavors were long confined to speculation in mystery, rather than to a solution of mys- tery; this tendency still prevailed suffi- ciently to dominate the mind of Hahne- mann; and, when by sophistry and mental gymnastics he secured public favor and was hailed as the Messiah of Medicine, he was content. Hahnemann had no bowing ac- quaintance with the spirit of science. As scientific knowledge has increased the number of so-called schools or systems of medicine has diminished. And the phrase, "the different schools of medicine," is to-day a phrase of convenience rather than of fact. It is to a great extent a relic of those times where we find many so-called schools, con- sisting mostly of vague theories grouped 13 MEDICAL SEMINAR DISCUSSIONS either under the names of the countries, where they were employed, or named after the glib-tongued fanatic, who claimed to expound them; or they received from some enterprising pretender a name suggestive of scientific value. To-day, when we say "medical school," we naturally infer a sys- tem; that is, a procedure based on reason and demonstrable facts and not on fantastic guesswork. But w r hy has there been such a clash of ideas even where there has been earnest en- deavor to relieve human suffering? To a very great extent this is easily explained when we take into consideration one great fact in nature relative to disease the fact that in many diseases there is a natural tendency to repair. This is known as Vis medicatrix naturae, the healing power of nature. It is obvious that in such diseases, if the applied remedy does not too much interfere with nature's process, the patient will get well; 14 HAHNEMANN and it is also clear that the medical enthusiast may proclaim a great discovery if the remedy is new, or increase his faith in it if it has been tried before. So we see that not only an ineffective but even a somewhat antagonistic remedy may be praised, and we also see how the apparent results of such pseudo-reme- dies could give rise to a Hahnemann system or any other transient school of medicine. The fact of overlooking this phenomenon the natural tendency to repair has given rise to more false clews to curative agents than all other errors combined. Of this, Hahnemann's system was a typical example. It was a very essential part of Hahnemann's teaching that nature is a bad physician and not to be trusted, that drugs are the only curative agents, but, contrary to this asser- tion, he reduced his dosage to the infinitesi- mal and left nature to work the cure. Though we may be charitable and con- cede some credit to Hahnemann for his 15 MEDICAL SEMINAR DISCUSSIONS negative aid to medicine, yet we have one particular grievance against him, and that is for climbing over the fence and tacking a name on another school. The first evidence of the individuality of a school is manifested in the name taken unto itself. When Hahne- mann established his school and named it Homeopathy, he also took the trouble to name the old school, Allopathy. The word Homeopathy was taken from two Greek words meaning "like" and "feeling." Thus it somewhat symbolizes this system of medi- cine* that selects a remedy, which, when given to a well person, causes the same feeling or symptoms as those caused by the disease. He then proceeded with disdain to name the old school, "Allopathy," also from two Greek words meaning "other" and "feel- ing," signifying that the old school used remedies which caused a different feeling than that caused by the disease, and, Hahne- mann notwithstanding, such a remedy might 16 HAHNEMANN not be a bad one. To make assurance doubly sure in conveying his idea, he proclaimed loud and long, "Similia similibus curantur" likes are cured by likes. This motto had ex- existed however long before its adoption by Hahnemann. In fact it had been formu- lated by Hippocrates and later used by Paracelsus. Paracelsus! that great expo- nent of a school of boasting and medical dishonesty. There is a seeming analogy between this likes-cured-by-likes idea and some of the best recognized remedies of to-day; for in- stance, the serum treatments and vaccina- tion. But these agents depend upon the principles of immunization, of which Hahne- mann knew nothing; nor was there a single instance in his medication to verify these principles whereby he might have shared the honor of his English contemporary, Edward Jenner. The one device original with Hahnemann was his infinitesimally small 17 MEDICAL SEMINAR DISCUSSIONS doses and his means of securing the ridicu- lous attenuation, which he claimed so neces- sary for liberating the spiritual power of the drug. But the day of reckoning confronted Hahnemann when he applied his system to chronic diseases. Those cases of ill health persisting after the administration of the precisely selected drug, most carefully atten- uated to its spritual potency, gave him pause. But Hahnemann's resources for reaching a conclusion were undaunted. After long concentrated study, he definitely decided that the itch was at the root of nearly all chronic diseases. In this part of his "re- search" work he omitted the ingenuity usually shown in his medical rubbish. In 1877, Dr. Wyld of the British Homeo- pathic Society published this statement, "That although many believe that the action of the infinitesimal in nature can be demon- strated, its use in medicine is practically by a large number all but abandoned." If 18 HAHNEMANN this was so over thirty years ago, it is un- doubtedly more abandoned to-day; and the question arises, what is being used in place of Hahnemann medication by those who claim to practice homeopathy? Are they grabbing drugs and dosage from another school, the very thing that Hahnemann him- self so bitterly decried in the Eclectics calling them a mongrel sect ? And those who depart from the doctrines of homeopathy, yet keep the name for the tone of moderation it still holds with some of the laity, do they do this in the spirit of medical integrity or commercialism? However, probably there are some who still believe in the Hahne- mann idea of infinitesimal doses, and even in olfactions or the smelling of such medi- cines. A comparatively recent writer on homeopathy goes beyond Hahnemann. He claims to have obtained decided results by means of drugs contained in closed bottles held in the hand. This very dream of 19 MEDICAL SEMINAR DISCUSSIONS attenuation is surpassed only by the ab- sent treatment of Christian Science. We can only say of such nonsense, "It is as fool- ish to deny as it is to believe," Among the schools, depending upon pop- ular indorsement, is the Eclectic system of medicine which as a system is rather paradox- ical, for, as Hahnemann pointed out, it con- sists in having no system of its own. Its followers choose from other systems what- ever they consider good. Though this has the appearance of frankness, in reality it is brazen assumption raised to the dignity of dogma. The true Eclectic avoids the discus- sion of principles, not that he has no ideas, but his ideas form no working system. Osteopathy is another so-called school. Here we might say we have a medical sys- tem without medicine, as we have an Eclectic medical system without system, and a Chris- tian Science system without science. Thus, if we attempt to analyze these sub-schools, 20 HAHNEMANN we are in a maze of hocus-pocus and f olderol. We know that all these advocate wholesome food, moderate exercise, proper rest, and sometimes restricted diet. In so far as that is a part of their teachings, they can do a great deal of good. But these and all other good means employed by the various sub- schools, from the power of suggestion of the Christian Scientist to the mechanical aid of the osteopath, are and always have been a part of the Regular School, where they re- ceive the fullest consideration and use ac- cording to their more or less scientific im- portance. There is but one system of medicine recognized by the great universities. This system, known as the Regular School, is based on scientific demonstration and rational procedure. This is the school em- ployed by the great governments, because, especially in matters of science, govern- ments now seek the guidance of the best 21 MEDICAL SEMINAR DISCUSSIONS universities. England, France, Germany, the United States, and all other countries of high intellectual achievement, insist upon having the very best medical care for their armies, and navies, and other important de- partments. Germany, ever anxious to recog- nize the work of a deserving son, gives no place to homeopathy in any of her universi- ties. The medical system of Hahnemann is condemned by all men who have anything to do with biological science. Imagine our government sending a lot of Homeopaths, Eclectics, Osteopaths, and Christian Scientists to supervise the matters of health on the Isthmus of Panama, when the great work of the canal was commenced. That fever-stricken zone, up to that time, had appalled the world with its death rate, but our government sent the best medical men obtainable and they were all of the Regular School. To-day that district has a health record as good as any place in our country. 22 HAHNEMANN Medical jurisprudence is founded on the Regular School. We also notice that large institutions as railroad, steamship, and life insurance companies, wherever their respon- sibilities are related to conditions of health, employ the Regular School of Medicine. With this preponderance of evidence for the indorsement of a rational system, it is not clear why so much favor is otherwise be- stowed by the laity, but such is the case. In San Francisco, those claiming to practice homeopathy have a very large following; and in Los Angeles the matriculation list of one of the schools of osteopathy is larger than the total enrollment of the ten medical colleges of the Pacific Coast ; and thousands throughout the land are pinning their faith to Christian Science; and we see by the daily papers that even the modest Munyon claims his share. And one more instance of the medical resources, which depend upon popu- lar indorsement, is a quack nostrum for the 23 MEDICAL SEMINAR DISCUSSIONS distribution of which two astute men, it is said, have sold the earth in territorial rights. These two men are now highly respected for their wealth, and one is an instructor in a Hahnemann school. An explanation of this public attitude is not forthcoming from the trite saying, "The public wants to be humbugged." Though that expression may serve as a flattering unction to the soul of a successful knave, it is a vicious slander of those most in need of help. In striving for health, women form the greater part of the deluded public. They are charmed with the ease of taking little sweetened pellets with such sophistry as, "If the medicine does no good, it will do no harm." And they consider it especially suited for children if it is a medicine of pretty color, pleasant taste, and perfectly harmless, and of course the disciples of Hahnemann can deliver the goods. It is to be regretted that the public has 24 HAHNEMANN been misled by the word "allopathy," for it is frequently though very wrongly used with reference to the Regular School, which should be known by its correct title. A prac- titioner of the Regular School resents being dubbed with this nickname, "allopath," coined by an exponent of a sub-school. And when he is asked by Mrs. Somebody if he is an allopath, let him say, NO, that he belongs to the Regular School. And let him remem- ber that for this little annoyance he is in- debted to Samuel Hahnemann. 25 FLORENCE NIGHTINGALE* A REMARKABLE concept has from the earl- * * iest times pervaded the human mind. It is portrayed in Greek drama, hinted at through all literature, and crystallized into the expression, " Coming events cast their shadows before." This adage is strikingly exemplified in the life of Florence Nightin- gale. The family name was Shore, but the father had inherited the estate of his grand- uncle, Peter Nightingale, on condition that he adopt the name of Nightingale. Later the family was sojourning in Italy and residing at the villa Colombaia, near the city of Flor- ence. It was here that our heroine was born, May 12th, 1820, and named Florence. A coincidence of names may be noted : Night- ingale, meaning night-song or lullaby; Co- * Read at the Medical Seminar, University of California, April 3, 1912. 26 FLORENCE NIGHTINGALE lombaia, kindred with the ancient word for dove, the symbol of peace and human com- fort; and Florence, suggesting the goddess of flowers or gentle gladness. It was a strange coincidence that these names were assembled with the seeming purpose to in- augurate the advent of a child, who in after life was to fulfill so grandly and so com- pletely their prophetic omen. The early education of Florence Night- ingale was not only replete with the womanly accomplishments of her time but her father, being a well-informed man, took care to direct her in more vigorous study. She be- came especially proficient in Latin and mathematics, thus developing the faculty of comprehensive and logical expression which was of the highest importance in her later work. We see this faculty manifested amid the confused and tangled conditions of the military hospital, where, by her concise direc- tions, order was restored ; we see it when with 27 MEDICAL SEMINAR DISCUSSIONS her pen she exquisitely defines an inherent quality or a noble aim of womanhood. Flor- ence Nightingale had in the fullest sense "the prepared mind," the mind that could instantly profit by a circumstance or combat any emergency. To Miss Nightingale nursing always meant more than handling the spoon and bottle, and applying the poultice. To her, nursing signified the proper use of fresh air, light, warmth, cleanliness, quiet, the proper selection and administration of diet, and all these with the least expense of vital power to the patient. She saw a bewildering error in the idea then prevalent, that every woman was a good nurse. She knew the absolute necessity of training and study for efficiency in such work. To her, hysterical devotion and the polite attribute, "woman's intui- tion," had little or no value. She could not conceive that a qualified nurse ever fell from the clouds. She demanded a proper combi- 28 FLORENCE NIGHTINGALE nation of what nature does for the woman and what the woman does for herself by training and study. Florence Nightingale was absolutely frank. She said, "If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is very often the fault of the nurse." Again and again she emphasizes the idea that the nurse should be able to discern all the discomforts of a patient which are not really essential to the disease, and should with. precision and promptness relieve the patient of those discomforts. By obser- vation she knew the elimination of discom- fort meant quicker and better recovery. When a child, Florence Nightingale showed characteristics which pointed to her vocation. Her dolls suffered much from ill health; under her care they would make a remarkable recovery in a few hours, only to be consigned to their beds again the next day with some new complaint. Childhood 29 MEDICAL SEMINAR DISCUSSIONS is always interesting but especially are we fascinated by the childhood of men and wo- men of genius. If time permitted it would be delightful to mentally visit Lea Hall, the first English home of Florence Nightingale ; to notice that substantial structure with gray stone steps, and on entering to see the old flag-stone floor and, a little beyond, the oak stairway where the gentle child first struggled with the ups and downs of life. Across the meadows from Lea Hall are the remains of the mansion of Dethick, where Anthony Babington dwelt when he and John Ballard conspired to release Mary Queen of Scots; and nearby stands the little Dethick church, where Miss Nightingale first attended public service, and fifty per- sons were an overflowing congregation. We might imagine the quaint service in Miss Nightingale's youth, when the old clerk made responses to the parson. Trying to trace the relation of early environment to the 30 FLORENCE NIGHTINGALE sequence of after life is always satisfying, even though in the cool summary^ of facts these tracings often fade. In England, as in other densely populated countries, poverty and disease made painful contrast to the wealth and elegance of per- sons of the rank of Miss Nightingale. The daughters of affluence employed part of their leisure in visiting the cottages of the poor, and in ministering to the sick and aged. Miss Nightingale thus began her appren- ticeship to a noble work. Not content with the limited field for this work on her father's estate, she visited the nearest hospitals and seriously studied the art of nursing, reading all she could find in her father's library re- lating to the treatment of disease and the management of hospitals. This w r as not done in the spirit of faddism nor with the effervescence of a brief enthusiasm so often seen in young women. Miss Nightingale studied her subject as a man studies that 31 MEDICAL SEMINAR DISCUSSIONS which he earnestly desires to understand. She extended her sphere of study to the hospitals and asylums of London. These institutions were large and liberally endowed, but they abounded in abuses and defects of every description. Most of them had good physicians, but in many instances the physician's skill was balked and frus- trated by the blundering ignorance or the obstinate conceit of the nurse. Everywhere was seen the need of better nurses, the need of women trained and educated to this line of work. Miss Nightingale was a devoted member of the Church of England, but in her reli- gion she was neither bigoted nor excessive. She did not let the attachment to her own church blind her to the excellencies of others. During her travels through Europe in 1845, she often met the Sisters of Charity and members of other Catholic Orders, serving in the hospitals w 7 ith such constancy and skill 32 FLORENCE NIGHTINGALE as to excite in her the greatest admiration and respect. In 1848, she entered a school for nurses in Germany and remained there many months where she became distin- guished for ability and thoroughness. On her return to England, she became the super- intendent of the Hospital for Aged Govern- esses, giving to that institution both her services and a large part of her income. This was the nature of her work until her extra- ordinary services in the Crimean war, after which she continued to promote the art of good nursing not only in England but gave her help in this splendid work to other countries. It is mostly due to the influence and assistance of Florence Nightingale that \ we now have over seventy-five thousand skillfully trained nurses in the United States. In 1854, Miss Nightingale had the oppor- tunity to employ her talents in the extreme hour of need. During February and March of that year, ship-loads of troops were leav- 33 MEDICAL SEMINAR DISCUSSIONS ing England for the seat of war with Rus- sia. Foresight and proper method seemed utterly wanting in those who had charge of sending the twenty-five thousand British troops to the shores of the Black Sea. The rigidity of routine in the British service was extreme, and the confusion and misman- agement abominable. There were supplies in abundance but often no one at hand who was authorized to serve them out, and it was thought a wonderful degree of courage in a surgeon, when he actually took the respon- sibility of appropriating some blankets for the use of the sick in a temporary hospital. One part of the army would have tons of meat and no breadstuff s ; another part would have an abundance of food for the men but none for the horses. One camp was ten miles from the sea, and the only conveyances for supplies were heavy carts drawn by cattle at the rate of a mile and a half an hour. By this method an army of twenty-five 34 FLORENCE NIGHTINGALE thousand men and thirteen thousand horses were to be fed. To this was added the scourge of cholera. In one division men were dying at the rate of twenty a day. Can the distress be imagined? On the 13th of September, twenty-seven thousand British troops landed on the shores of the Crimea and marched inland six miles. There was no foresight to put a road in proper condition for hauling supplies, al- though plenty of rock and gravel were close at hand. It began to rain. The rain soon *fell in torrents. It was almost impossible to haul a supply-wagon through the deep mud, and the soldiers with blankets and clothes drenched with rain suffered the unneces- sary torture of long intervals without food. Another instance of mismanagement was when the admiral's ship signaled to send all sick men to a certain vessel. Before night there were fifteen hundred sick soldiers and sailors crowded to suffocation on that ves- 35 MEDICAL SEMINAR DISCUSSIONS sel, with a scene so full of horror that the de- tails were deemed unfit for publication. And then it was discovered that the vessel was un- seaworthy, and the fifteen hundred sick men had again to be transferred to other vessels. On September the 20th, the battle of Alma occurred with no preparation for the proper care of the wounded. In all the mel- ancholy history of warlike expeditions, there is no record of one managed with such cruel inefficiency. On the 10th of February, out of forty-four thousand British troops, eighteen thousand were in the hospital. The word "hospital" when used in reference to the Crimean war can only conjure up scenes of horror. The battlefield, cholera, typhus fever, and frightful mismanagement all con- spired to make those conditions which were described by Miss Nightingale as "the lowest sinks of human misery." When England heard of the dreadful mismanagement and realized the neglect of the sick and wminded 36 FLORENCE NIGHTINGALE after the battle of Alma, a call went forth for skilled nurses. There was but one woman in England qualified to assemble and direct such a band that woman was Flor- ence Nightingale. The secretary of war wrote a letter to Miss Nightingale asking her services; this letter was crossed on its way by a letter from Miss Nightingale offering her services. Within two weeks Florence Nightingale and her selected staff of nurses reached the seat of war. Some of the officers anticipating the arrival of the nurses ventured the remark that the rats in the hospital would frighten the wits out of the women. It so happened that one of the first things Miss Nightingale noticed upon entering the wards was a rat slipping in behind some boxes. She did not ponder on the etiquette of woman's emotions nor ask for the revised statutes of woman's rights, but grabbed an umbrella and dis- lodged that rat so quickly that the officers 37 MEDICAL SEMINAR DISCUSSIONS dismissed all thoughts of timidity or lack of mettle in these brave women. Miss Night- ingale found the hospital at Scutari reeking with filth and pestilence, but, when she mar- shalled her forces with mops and cleansing fluid, the microbes were convinced that "the female of the species is more deadly than the male." Ten days before the nurses reached their destination the battle of Balaclava was fought, where so many brave men were mangled in that terrible Charge of the Light Brigade ; and the day after their arrival the battle of Inkerman was fought. The wounded arrived at the Scutari hospital in ship-loads. All the wards were soon crowded and through the long corridors the maimed and dying lay in double rows. Proper relief seemed the despair of human effort. But Florence Nightingale with self- possession, firm determination, and a readi- ness for emergency unequalled among her 38 FLORENCE NIGHTINGALE sex, took up her task. Within ten days she had improvised a large kitchen and a laundry, and systematized the distribution of food, surgical dressings, and medicines. And her scissors severed any army red-tape that withheld necessities from the sick. The English government had empowered Miss Nightingale with all possible authority for carrying on her work, but she never used nor abused authority except on the side of mercy. She proclaimed, "There must be no needless suffering, no starving, no lack of care, no mistakes, no confusion, but there must be order, cleanliness, and every pos- sible comfort." Her work had now begun, and whether in the store-room directing the blows of a swarthy Turk to open cases for the proper distribution of supplies, or at the bedside insisting on more and better nourishment, or seeking instructions from the surgeon, her efforts were concentrated and effective. 39 MEDICAL SEMINAR DISCUSSIONS In the records of the Crimean war, two facts affect us beyond all others the horror at what the army suffered and the admira- tion for the genius of a woman to relieve that suffering. Miss Nightingale's efficient work, we should bear in mind, was not the outcome of mere generous impulse, it was the fruit of thorough preparation, the re- sult of years of training and study; yet all her training, and study, and power of leader- ship, and authority never obscured the essen- tial womanliness of her nature. The depth of her sympathy might have seemed the greatest of her qualities to the soldiers she helped and comforted. The intense sorrow excited in her by distress in others was feminine, but to feminine compassion she added the quality of masculine scope and purpose. The fall of Sebastopol on September 8th, 1855, ended the war. The news soon reached London. The Tower guns proclaimed the 40 FLORENCE NIGHTINGALE victory; the bells of the cathedrals and of every village church pealed forth the joyful news; and on every hand the praises of the victorious army were mingled with the name of Florence Nightingale. But, in the hos- pitals at Scutari and at Balaclava, the sick and w r ounded still remained, and there Florence Nightingale remained still fighting the battles of her holy war against the pain and misery around her. She also engaged in promoting plans for the recreation of convalescent soldiers and of those forming the army of occupation pending peace nego- tiations. Small libraries, lecture rooms, and a coffee-house were established as counter- attractions to the canteen. Such counter- attractions were of much importance to "Tommy Atkins," who, flushed with the spirit of victory /'was apt to drink healths most recklessly and to make each day an anniversary of the fall of Sebastopol." Not until all the hospitals were closed and 41 MEDICAL SEMINAR DISCUSSIONS the last part of the British army had orders to sail, did Florence Nightingale quit the scene of her labors. After nearly two years of devoted service, she returned from the Crimea to her home. All England throbbed with gratitude. She received the homage of the royal family. Parliament changed the law that the highest mark of merit might be bestowed upon a woman. The Queen of England gave her a cross beautifully formed and emblazoned with gems. The Sultan of Turkey sent her a bracelet clus- tered with magnificent jewels. But, as a matter of fact, no king nor queen could add to the glory of Florence Nightingale. She was lifted and sustained by the glory of her own genius, and on her brow was placed the diadem of gratitude of all mankind. Florence Nightingale was one of the few great innovators who lived to see the world fully realize and adopt the benefits of their work. She died at the age of ninety. Eng- 42 FLORENCE NIGHTINGALE land would gladly make a place for her in Westminster Abbey, but for her oft-re- peated wish to lie in a quiet country church- yard. In benefits to her country and in con- tributions to the w r orld, all the host of women in public endeavor, without special training and study, can not equal her sum. The Greek muses could have said, "The work of a menial was touched by a splendid woman, and it was reshaped and dignified to the admiration of the gods." In Florence Nightingale was the sub- limest union of heart and brain. Humanity will never be decorated with a more beauti- ful flower of womanhood. 43 UNIVEKSITY OF CALIFORNIA LIBRARY BERKELEY THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW Books not returned on time are subject to a fine of 50c per volume after the third day overdue, increasing to $1.00 per volume after t'lfe.ixth* 1 d-ay. Books not in demand may be renewed if application is made before expiration of loan period. EC 25 1983 --