It was not the Crimean War itself, but the period shortly after the War which witnessed the greatest changes in British Army Medicine and Medical Practice. Despite the favourable account given in Dr Dartnell’s account of the treatment of the soldiers at the time of Queen Victoria’s visits to Fort Pitt Military Hospital, all was not well within the Army Medical Service. The War which saw, more men die from diseases like cholera, than service wounds, witnessed the fact that it was high time for reform. This need was heightened because public attitudes towards the private soldier had been transformed by the War.
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Forty years before the Duke of Wellington had described his army as : “The scum of the earth enlisted for drink” and attitudes had not changed much since then. The Crimean War was to change this simply by making people aware of the conditions in which the private soldier lived, fought and died. (link) The dispatches sent back to ‘The Times’ by William Russell did much to help this (link) However, it was, perhaps, the work of Florence Nightingale which really caught the public eye.(link)
If Nightingale’s lasting victory at this time was to elevate nursing into a profession, her other great aim was to see that the incompetent Army Medical Service was reformed. Here her obstacles were mountainous as she found herself, a woman, battling against centuries of tradition and miles of War Office red tape. Undeterred, she was determined that the health and diet of the private soldier should receive as much attention in peace as in war. With this in mind, she began to gather statistics and other information which would support her case and it was a fact-finding mission which first brought her to Fort Pitt in November 1856.
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Now Nightingale was pushing hard for the creation of an Army Medical School which would train young surgeons for the medical conditions which would confront them in ‘military’ as opposed to ‘civilian’ medicine. She confirmed the need for such a school when she wrote : ‘Formerly young men were sent to attend to the sick and wounded who perhaps had never dressed a serious wound, or never attended a bedside, except in the midst of a crowd of students. Following in the wake of some eminent lecturer, who certainly had never been instructed in the most ordinary sanitary knowledge, although one of the most important functions hereafter was to be prevention of diseases in climates and circumstances in which prevention is everything and medical treatment little or nothing’. .png)
Florence Nightingale made what must have been a number of visits to Fort Pitt prior to the opening of the Army Medical School in October 2nd 1860. Her great ally in reform of medical care in the Army was the Secretary of State for War, Sydney Herbert. The first step towards reform was made in 1857 when he was appointed as President of the ‘Royal Commission on the Health of the Army’ which began sitting in May of that year. It was later in that year that he recommended the setting up of an Army Medical School and by the end of the year, Nightingale had drawn up the regulations and nominated the teachers. However, when in October 1858 a Royal Warrant was published which laid down the rules for the future admissions, promotion and retirement of Army Medical Officers, no provision was made for setting up a staff of female nurses and it was envisaged that the sick would continue to be looked after by regimental hospital orderlies or men of the Medical Staff. These men were generally retired soldiers or pensioners paid 3 – 6 pence a day and free rations.
Nightingale, however, had already been instrumental in breaking with that tradition when her nurses in the Scutari Hospital in the Crimean with Herbert’s approval, Nightingale had swiftly assembled a cohort of 38 nurses to travel to Crimea. She favored young women from the lower classes, assuming they would be better-equipped to withstand the hard work and difficult conditions ahead. Once the War was over some of these were later already employed at the Fort Pitt Military Hospital. .png)
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The new School was to be self- governed by a Senate which was charged with the supervision of training of candidates for medical commissions. It was to be composed, prestigiously, with the Director General of the Army Medical Department as its first Principal Medical Officer. In addition, Sir Thomas Longmore (left) was appointed the Professor of Military Surgery and the great military sanitarian, Dr Edmund Parkes, was the Professor of Hygiene and there was also a Professor of Pathology. Implicit within the management of the new School was its autonomy and this was due to Nightingale’s influence. She had seen that the failures of medical arrangement in the Crimean War were due to the lack of executive power in the Army Medical Department and was determined to see that this did not happen to the new School.
It was at this point Fort Pitt enters the story as the chosen site for the School and its choice was an obvious one. Even before the Crimean War it had been a place of education, a school where young assistant surgeons picked up the military aspects of the profession. In addition, it had a scientific and educational basis in its museum and medical library and its long experience in dealing with soldiers’ ailments, medical conditions and service wounds. In the opinion of ‘Historic England’ in its survey report : ‘Fort Pitt was a major military hospital at which almost all soldiers invalided to Britain from the colonies were assessed prior to their discharge from service’ and ‘Fort Pitt was ‘de facto’, the most important military hospital’. (link)
In preparation for the arrival of the School, one ward had been converted into a lecture theatre and another into an operating ‘theatre’ designed to allow the young surgeons to observe the surgery, with other rooms converted for the professors and secretarial staff. Outside the main hospital other buildings were appropriated for a pathology laboratory known as the ‘Microscopical Room’ and there was a ‘Dissecting Room’. In addition, quarters and mess buildings were assigned to the officers in training.
After three years preparation, the opening of the School in 1860 was, according to Nightingale, ‘a disaster’. On September 3rd she wrote in her diary : ‘On Saturday I had a letter from the Professors of the Medical School quiet desperate. The authority for the instruments and the money had not yet come. Ten of the students arrived. They stared at the bare walls and in the absence of all arrangements for their work, concluded that the School was a hoax’.
The problem of the instruments was solved later that year when the School received a large teaching collection of surgical instruments, along with ambulance wagons and stretchers from Trinity College, Dublin. According to the ‘Medical Times and Gazette’, the first 43 students were reported to be an ‘extremely gentlemanly and fine looking set of men, of who the Service may well be proud’. Each student who, having passed the entry examination, followed a 5 month course of instruction which concluded with an examination in Hygiene, Pathology, Surgery and Military Medicine and those who qualified in these subjects were gazetted as ‘Medical Officers’.
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In 1862 Arthur Anderson became Inspector General of Military Hospitals and took over as Principal Officer at Fort Pitt. Prior to that he was educated at Maris College in Aberdeen and graduated with a medical degree from Edinburgh University in 1834 and served as a surgeon with the 82nd Foot, 10th Dragoons and the Rifle Brigade, before being appointed a Surgeon Major in 1854. He was in charge of Nightingale's hospital care in Scutari Hospital in the Crimean War when Nightingale had been stricken with 'Crimean Fever', now known to have been brucellosis and was acutely ill for twelve days, but later recovered and returned her duties at the hospital in Scutari.
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The school opened in 1860 with five sets of students attending before it was transferred in 1863 to the Royal Victoria hospital, Netley, Hampshire. Fort Pitt was a "practical" medical school with students attending for 4-9 months of clinical experience. This included "instruction in tropical medicine" delivered by members of the Indian Medical Service.
When the School moved it took with it, in addition to the School’s equipment, the contents of the medical museum where the pathological section alone had a staggering 6,000 specimens and the library of over 10,000 volumes. Anderson and his clerk, were the first personnel to leave and the remaining staff followed including Crimean nurses, like Sister Jane Catherine Shaw Stewart, who maintained correspondence with Nightingale and became the first Lady Superintendent in the Royal Victoria Hospital in Netley. This contingent of nurses now broke new ground and, by default, led to the recognition of female nurses in Army hospitals when, in 1866, much to Nightingale's approval, a Royal Warrant legitimised the appointment of female nurses to any military general hospital and subsequently they were then employed both at Netley and Fort Pitt. link Hospital patients were also moved physically from Fort Pitt to the Royal Victoria Hospital which was soon handling patients from Malta, China and India who formerly would have previously been taken to Fort Pitt before being discharged either back to their former regiments of from the Army as veterans. In 1865 Lord Panmure, now the Earl of Dalhousie, speaking in the House of Lords, offered an interesting insight into his thinking about why this was a good thing when he said : “A more unfortunate place for the reception of invalids than Fort Pitt never existed. Whenever any large body of invalids landed from the East, the place became a scene of the utmost demoralisation and many a non-commissioned officer had to regret that, while waiting there for his discharge he lost his stripes and pension attached to them. To avoid this was one of the objects contemplated by the erection of Netley Hospital”.
When he referred to their “demoralisation” he meant their being drawn into immorality and referred to the temptations of prostitutes and drink which, Victorian Chatham, on the Hospital’s doorstep, had in abundance, as opposed to Netley, which was isolated on the banks of Southampton Water. Despite the fact the removal of the Army Medical School to new Royal Victoria Hospital in 1863, must have dealt a blow to the prestige of Fort Pitt, it continued to be a site of some importance and in 1873 it became a ‘Garrison Hospital’ with its officers, for the first time, under the command of the Army Medical Department and not the local regiment.
At the end of the 19th century, superficially, the site of Fort Pitt had changed very little. All the defensive ditches around perimeter of the Fort were still in place and the Tower, casemates in the Blockhouse and underground chambers were still being used for Hospital purposes. On the surface of the site, the 1832 ‘H’ shaped hospital blocks and two houses for the Medical Officers and their families, were still in use, as was the 1847 Asylum. However, some change was apparent: Two new single story ward blocks had been built to the west and of the Tower and other buildings to house the dining room, stores, laundry and mortuary had been built at the front of the Hospital site. The building which had once housed the Museum was now converted into a Dental and Ophthalmic Block which also treated outpatients from troops based in Chatham. One day’s leave was given for the extraction of a tooth and the fact that the return for one month in 1915 read : ‘Cases treated : 1,137. Teeth extracted : 1,690’, provides some insight into the parlous state of the dental health of the servicemen at this time.
As the 20th dawned we have a description, in the local newspaper, of the Hospital’s Christmas in 1909, just before the outbreak of the First World War. It reported that those patients who could walk, sat down to a meal in the Dining Room which was laid out by the matron, nursing sister and staff nurses. The rest had their dinner in bed. After dinner the men of No10 company of Infantry and Special Reserve sat down to their meal in No18 barrack room (in the blockhouse) where they were visited by Lieutenant Colonel Cree who was about to leave for India. The N.C.Os, after waiting on the Company, sat down to their dinner at 3pm in the Mess Room. In the evening a concert was held for the patients in No 5 Ward.
The celebrations were brought to a close on New Year’s Eve, with a tea for patients and the families of the R.A.M.C followed by presents from a Christmas tree and a cinematograph show (link) on the ground floor of the Old Crimea block, little changed since Queen Victoria's visit during the Crimean War, fifty-five days before.
Five years later, the Christmas of 1914 would take place in the Hospital transformed by new buildings and the outbreak of the First World War. The dramatic modernisation of the hospital in the early 20th century and the impact of the War shall be dealt with in : 'Chapter Six : The New Hospital Wing and the First World War’.
John Cooper
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The new School was to be self- governed by a Senate which was charged with the supervision of training of candidates for medical commissions. It was to be composed, prestigiously, with the Director General of the Army Medical Department as its first Principal Medical Officer. In addition, Sir Thomas Longmore (left) was appointed the Professor of Military Surgery and the great military sanitarian, Dr Edmund Parkes, was the Professor of Hygiene and there was also a Professor of Pathology. Implicit within the management of the new School was its autonomy and this was due to Nightingale’s influence. She had seen that the failures of medical arrangement in the Crimean War were due to the lack of executive power in the Army Medical Department and was determined to see that this did not happen to the new School.
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