This is an attempt to analyze why nursing in Russia followed a different path of development after the Crimean War, although the number of nurses that had worked in the Crimean hospitals on the Russian side was much bigger than the number of British nurses. -author
As it is well known, the Crimean War (1854-1856) marked the turning point in the history of nursing. The outstandingly self-sacrificing work of Florence Nightingale and 38 British nurses, who worked day and night in Turkish hospitals, providing help and necessary care to the sick and wounded soldiers, was highly praised and acknowledged in Britain. Their hard labor and efficient management in improving sanitary conditions in the army hospitals brought about a new approach to women’s participation in hospital care. The results of the nurses’ activity during the Crimean War gave powerful impetus for developing professional nursing and establishing educational institutions for nurses throughout Europe. At the same time, the destiny of more than 300 Russian nurses who did the same job on the opposite side of the Crimean battlefields was different. Although their invaluable mission in hospitals, at bandage posts and in the battlefields of the besieged Sebastopol gained public recognition, development of nursing in Russia after the Crimean War followed an entirely different path.
The total number of Russian nurses who worked in the hospitals and at bandage posts in Sebastopol, Kherson, Simferopol and many other places is still disputable. The list of the main group of nurses – the nurses of St. Petersburg’s Krestovozdvizhenskaya Commune - includes 236 names. The list of the smaller group – the Compassionate Widows of Moscow and St. Petersburg’s Widow Houses – contains 91 names. Yet, there were some other women - officers’ wives and local residents, who voluntarily joined the above-mentioned communes or just came to work in hospitals as nurses, servants, or sitters, striving to alleviate the sufferings of the wounded. According to the research made by the Russian historian Valeri Durov1, Russian government stamped out 7 gold medals and 1450 silver medals to award women who had worked in the hospitals during the Crimean War. The places where the nurses provided care to the sick and wounded Russian officers and soldiers were listed on one side of the medal – Sebastopol, Perekop, Belbek, Bakhchisarai, Kherson, Nikolaev, Simferopol. This fact may be regarded as indirect evidence that the total number of women who worked in different places in Crimea during the war exceeded one thousand. However, even taking into consideration the nurses sent from St. Petersburg and Moscow, whose names are listed in the documents found in Russian State Historical Archive2 and St. Petersburg’s City Archive3, one can come to conclusion that by the end of the Crimean war, Russia had had at least 327 experienced and skilled nurses, which is approximately ten times more than the number of nurses worked for the British hospitals in Turkey. It would be natural to expect that these skilled and experienced women might have launched fast development of nursing in Russia. However, it did not happen. The majority of the nurses that took part in the campaign either retired right after the war or returned to the communes of nurses in their native cities, while only a handful of them were employed as nurses in two military hospitals in Kiev and St. Petersburg in 1856.
Doctors who had worked in the Crimean hospitals highly praised nurses’ activity and paid tributes to their selflessness, indefatigable labor, and sympathetic attitude to the sick and wounded warriors. Here is a short extract from the report of the two Russian doctors who inspected a number of hospitals in the Crimea during the war.
Compassionate nurses of the Krestovozdvizhenskaya Commune of Nurses must be regarded as medical ranks. Ten of them worked in the Military Temporary Hospital Number 11 and five other nurses worked in the Military Temporary Hospital Number 3. Motivated by the highest spirit of selflessness, compassion and humanity they proved to be the most precious assets to the hospitals. To take care of the wounded, to inspire the sufferers with the hope of recovery, to say prayers, to suffer and rejoice with them – all this was only possible for the women with the highest sense of responsibility. The nurses of the Krestovozdvizhenskaya Commune really were such women. Any doctor who had such a helper was sure that all the prescriptions would be performed perfectly. The nurses not only looked after the tidiness and clean linen, but they also distributed medicines, put on cupping glasses [Bier’s cups], applied Spanish flies, put on bandages, etc. In short, the compassionate nurses were the best helpers for the doctors and they were truly the best friends and patronesses for the patients.4
On the other hand, the same report reveals a rather different and controversial approach towards nurses. Medical officials did not like at all when nurses tried to improve management and started interfering into the administration of hospital care.
Nurses demonstrated all these qualities only in the beginning of their activity. However, since they had started interfering in all the parts of hospital administration, considering themselves utterly independent, they dodged performing their direct responsibilities.5
Actually, the nurses were very worried about the poor conditions in the Crimean hospitals and tried to improve the sanitation standards and regular supplies of the medicines and necessities, criticizing the authorities for their sluggishness, helplessness, neglect and mismanagement. In some hospitals, they openly fought against thievery and corruption, quite typical for the Russian army those days. Many practical doctors who worked in the field hospitals were dissatisfied with the management and administration as well and they supported nurses in their initiative to change the appalling situation with delivery and distribution of basic supplies in the hospitals. The famous Russian Surgeon Nikolai Pirogov, who was in charge of the nurses’ activity in the Crimean hospitals, favored the idea of granting nurses free hand in management and he believed that nurses should be appointed to the administrative positions in hospitals with higher responsibilities. However, just after the Crimean War he suddenly retired (allegedly, after a fierce argument with the military minister), so that Russian nurses lost their main protector and patron in supporting their interests and initiatives among hospital authorities. Regrettably, none of the other medical officials turned out to have such influence, as Pirigov had had, to defend nurses’ status in military hospitals and promote nursing as an essential element of hospital care.
Meanwhile, Russian system of hospital care was in deep decline at that time, because the authorities had not paid attention to hospital development since the Napoleonic Wars. It was yet before the Crimean War that the central authorities had been informed about the dreadful conditions in hospitals, numerous shortcomings and the outrageous abuse of power by the hospital administration almost everywhere. It was one year before the war that the Chief Inspector Kruglov reported to the Military Ministry about lack of proper care of patients, poor sanitary conditions, corruption and larceny among hospital workers at all levels, as well as numerous other failings. However, the ministry did not pay any attention to the report and it was shelved until 1859.6
The Crimean War exposed all the shortcomings and exacerbated all the drawbacks that had accumulated during the decades of neglect. The appalling conditions in hospitals, lack of basic supplies, mismanagement and corruption among the authorities played their fatal role and resulted in the huge loss of lives of the sick and wounded soldiers. Nurses, who could not stay indifferent to the horrendous conditions in hospitals, were trying to improve the situation. Being encouraged by some of the senior doctors, Pirogov inclusively, they often insistently interfered into the management and administration, which annoyed and irritated the military hospital authorities. Although the authorities admitted much of the criticism, they could not give up prejudice against female capabilities in administrating and refused to accept the idea that nurses would be delegated certain responsibilities and legal rights to take part in hospital management.
Despite nurses had demonstrated their best qualities during the Crimean war and their contribution to the improvement of hospital care had been recognized internationally, Russian authorities were reluctant to the idea of introducing female nursing in military hospitals after the war. The officialdom also strongly rejected the idea of nurses’ participation in hospital administration, though the government did attempt to reform hospital care. In 1858, the Military Ministry assigned Dr. Yanovsky, the senior medical officer in charge of the special tasks, to prepare a draft project of a new hospital statute7. The draft project called for drastic changes in hospital management at all levels and many suggestions seemed quite revolutionary those days. Among the points included into the project was the requirement to delegate the administration of every hospital to a special independent collective council that would consist of a doctor consultant, chief physician and a senior nurse. The management and all the staff responsible for maintenance and supplies were supposed to become subordinate to the above-mentioned council. Therefore, it is possible to conclude that, according to this draft project, nurses were supposed to be working in every hospital and they should have taken active part in hospital management. The draft project was sent out for consideration to all the top military officials and chief doctors of the military hospitals. A special committee was set up to discuss the proposals listed in the draft project and to introduce the concept that would be suitable for the majority of hospitals. However, all the suggestions on radical changes remained just some nice ideas on paper.
The members of the committee for elaborating the new hospital statute disagreed upon the role and mission of nurses in military hospitals. A number of officials and chief doctors were convinced that nurses would be useless; some others even claimed that nurses would do considerable harm to hospitals once they were allowed to take care of the patients. In contrast, a few members of the committee insisted on including nurses into hospital staff and put it as one of the mandatory requirements for hospital reforms. They asserted that hospitals would have benefited greatly if nurses had taken care of the patients on a permanent basis. The ones who supported the idea of nursing were mainly the doctors who personally worked in military hospitals during the Crimean campaign. They pointed to the fact that nurses demonstrated a much more conscientious and compassionate attitude towards the sick and wounded in the Crimean hospitals, comparing to feldshers and other hospitals staff.
One of the ardent supporters of nursing was Dr. Paltsev, the Chief Doctor of Moscow Military Hospital and one of the committee’s members. He wrote, based on his experience of working in Kherson hospital:
If distribution of medicines and care had been handled by the feldshers and other hospital staff, not by nurses, then the patients would not have had even a half of the prescribed medicines, food and vine, while the staff (feldshers and servants) would have been constantly drunk. It was only owing to nurses’ indefatigable toil that the hospital in Kherson had only 400 patients by September 1857, while the number of them in 1856 exceeded 5, 000 and the total majority of them recuperated.8
However, this point of view was not at all popular among the officialdom. After the debates lasted for over one year, the committee passed a resolution to approve a few proposals on minor changes that had been backed up by the majority of the military and medical officials, while the radical changes were postponed. Although the committee agreed to try out some of the more resolute proposals in three remote hospitals, it is obvious that Russian medical authorities were not ready to carry out drastic reforms. As it often happened in Russian history, bureaucracy had a stranglehold on the common sense. As a result, nurses were engaged in hospital care only in two military hospitals, whose chief doctors insisted on the necessity of nurses’ participation in hospital care – the 1st Sukhoputny (Land) Hospital in St. Petersburg and the Military Hospital in Kiev. The officials of the Kievsky Military Hospital managed to obtain official approval for the 12 nurses that had been working there since the Crimean War. According to the governmental resolution, these 12 women were included into the hospital staff with the annual pay of 198 rubles, which was a rather high salary for those days. Their responsibilities were not only to take care of the patients treated in the hospital, but also to supervise the work of servants and other lower hospital staff.9
It was only in 1860 that the officials gave their consent to engage a handful of nurses in a few other hospitals as an experiment, so that nurses officially appeared in military hospitals located in Moscow, Brest-Litovsky, Warsaw, Riga, and Kherson.10
Two years later, in 1862, the new draft project for the reforms in hospital care was introduced. The special committee was set up again and this time the debates over the necessary changes lasted for over seven years. At last, the new hospital statute was approved by the Emperor and it was officially put into effect in 1869, more than 13 years after the Crimean War. However, this new hospital statute did not do much for the development of nursing in military hospitals yet again. Nurses were allowed to be engaged in taking care of the patients in military hospitals, only provided that the chief doctors found it necessary, which definitely put nurses under strong dependence on the personal attitudes of the chief doctors. At the same time, according to this document, nurses did not have responsibilities of supervising the other medical staff, maintenance and supplies. Their activities were confined to distributing drugs and taking care of the patients.
Meanwhile, similar to what had been observed before the Crimean War, nursing went on developing as a private initiative in the society. New communes of nurses were set up in St. Petersburg, Moscow and many other different cities all over the Russian Empire. The work of the Krestovozdvizhenskaya Commune of Nurses and other nurses during the Crimean War set an example of the noble impulse and devoted labor and it also shown a possibility of a career for women. The nobility and some of the members of the Tsar family provided support for the nursing communes and even attempted to gain the employee status for nurses in hospitals.
In 1856, the Great Duchess Elena Pavlovna, the founder and the patroness of the Krestovozdvizhenskaya Commune of Nurses, sent a memorandum to General Sukhozanet, the Military Minister of the Russian Empire, suggesting engagement of nurses for taking care of the sick and wounded in the military hospitals. The Military Minister submitted a relevant report to the Tsar, who, in his turn, ordered to appoint a special commission for discussing the issue on October 17, 1856. The commission, chaired by General Knoring, consisted of top military officials and some members of the state medical council. The only woman that represented nurses’ interests at the commission’s sessions was Ekaterina Bakunina, the head nurse of the Krestovozdvizhenskaya Commune of Nurses. The majority of the officials did acknowledge importance of nurses’ care and some of them even believed that nurses would revamp hospital care. At the same time, none of the officials agreed to allow nurses to interfere in hospital management and all of them insisted that nurses should never be allowed to partake in any administrative bodies or supervising councils of hospitals.
After a few months’ work, the commission elaborated a set of rules and regulations for the nurses’ activity in hospitals, as well as the relations between nurses and hospital authorities, but the officials decided not to submit the draft project of the rules for nurses for the Emperor’s approval until the new hospital statute was implemented. However, the debates around the new hospital statute lasted for a few more years, so that the draft project of the rules for nurses was shelved until 1865, when the special commission returned to the draft and suggested a few more changes to the initial set of rules.
The bureaucratic games around the status of nurses in the military hospitals continued until the end of the nineteenth century. Every time a new military campaign started, the officials would remember about nurses, but they would forget to establish the proper status of nurses every time the campaign was over. Although the number of the religious communes of nurses was increasing, there were also many women who wanted to become nurses without joining a religious commune. Nurses and nursing remained a private initiative and it was mainly supported by private individuals and charitable councils until the Society for Assisting the Sick and Wounded Worriers, which was later known as Russian Red Cross, was established in 1867.
1. Rodina (Motherland, historical magazine), July 2000.
2. Ob Otpravlenii Serdobolnykh Vdov v Krim (On Sending Compassionate Widows to the Crimea), RGIA, fond 758, opis 13, delo 161, 162; RGIA fond 759, opis 31, delo 1147, 1148, 1149, 1150, 1151.
3. Krestovozdvizhenskaya Commune of Nurses, St. Petersburg’s City Archive, fond 392.
4. On Typhus and Fever in the former Southern Army in the end of 1855 and the beginning of the 1856 by Sokolov M. and Kiyakovsky. F., St Petersburg 1857.
5. On Typhus and Fever in the former Southern Army in the end of 1855 and the beginning of the 1856 by Sokolov M. and Kiyakovsky. F., St Petersburg 1857.
6. Glavny Voenno-Sanitarny Komitet [Historical Survey of the Main Military Sanitary Committee], St. Petersburg 1902.
7. Glavny Voenno-Sanitarny Komitet Historical Survey of the Main Military Sanitary Committee, St. Petersburg 1902.
8. Istoriya Moskovskogo Voennogo Gospitalya 1707-1907 [History of Moscow Military Hospital] by Alelekov A.N., Moscow 1907
9. The Full Code of Laws of the Russian Empire, vol. XXXV, article 35688.
10. Istoriya Moskovskogo Voennogo Gospitalya 1707-1907 [History of Moscow Military Hospital] by Alelelkov A.N., Moscow 1907.
Ed. Note: Yuri Bessonov is a Russian physician who works as a translator, independent researcher and a freelance journalist in the fields of nursing history and history of hospital care. He has carried out extensive research in the history of nursing in Russia and in some European countries.