A man came limping by in the care of a nurse. She held him roughly by the elbow as he clutched a bloodied bandage wrapped around his middle. The poor man grunted in pain as the nurse pulled him along to some unknown destination.
I tasted bilious anger in my mouth. Had these appalling conditions always existed not a half mile away from me?
“Ah, Miss Nightingale, good of you to come.” Goodfellow greeted me with both warmth and relief. “I will escort you to our meeting room. The other physicians are waiting to meet you.”
I had been to these sorts of “meetings” before with the Establishment’s management. They were usually opportunities to attempt to bend me to someone else’s will.
That was not going to occur today.
“I think not,” I said decisively, folding my hands in front of me and raising my chin.
Goodfellow seemed genuinely taken aback. “Pardon me? Have you decided not to help us? Obviously, you must have seen how overwhelmed we are simply by the number of poor souls outside.”
My temper flared with righteous indignation, and for once I didn’t even mentally chastise myself for it. “Based on what I have seen so far, I suspect the poor people dying out on the lawn have it better than anyone imprisoned inside the walls of this place.”
His response was both gentle and apologetic at the same time. “Yes, there is much that can be improved upon here. We do the best we can.”
I was unsatisfied with his answer. “Sir, this is your best? Look at this atrocity.” I pointed with a gloved hand at the wall. “Surely there was a moment in time when you could have hired workmen to redo these walls.”
He seemed nonplussed by my outburst. “Surely you must realize that we operate with few funds, Miss Nightingale.”
“Is it expensive to open windows? To sweep floors? Before I meet with anyone, I should like to visit the corridors of this hospital.”
Goodfellow looked around as if noticing for the first time the conditions to which I was objecting. He shrugged. “It is perhaps not as clean as Buckingham Palace, but we are here to save lives, not to impress guests.”
I followed him as he showed me several hospital wards. It was a much larger hospital than the Establishment and had both men’s and women’s wards on each floor, plus there was a special maternity ward. Each ward was a long, wide hallway. About twenty beds lined both sides of each ward, with headboards up against the walls—walls that were as moldy and peeling as those in the entryway. How long had it been since the walls were scrubbed?
However, the room’s arrangement was efficient, as it allowed doctors, nurses, and orderlies to go from inmate to inmate quickly.
Unfortunately, the staff appeared to be moving as if gelatin were attached to the bottoms of their shoes.
Every bed I saw was filled, and some inmates lay on lumpy mattresses on the floor between beds. Everyone seemed to be either in pain, dehydrated, or seemingly unconscious. Many of them were obvious cholera victims. At least there were multiple tall windows in each room, yet they all remained tightly shut. The sunshine filtering through the dirty panes did nothing but illuminate the dust floating in the air. It was difficult to breathe in the hospital, so sealed off was it.
Dr. Goodfellow stopped to greet a young man in one of the men’s wards. He was a boy, really, and I guessed he had been in some sort of factory accident that had mangled his right arm, which was wrapped in bandages and showed an obvious stump at the end.
While the doctor attended to him, I walked on, examining other areas. The supply cabinet was disorganized and did not contain an adequate provision of bandages, morphine, syringes, stethoscopes, or invalid drinking cups. I heaved a sigh in disgust as I shut the cabinet doors.
The water closets were too wretched to even describe. I stepped away from them as soon as the doors were opened for me; the vile smell told me all I needed to know.
I asked to see the kitchens, by which time Dr. Goodfellow had rejoined me. I was in too much of a rage to even speak as we went into the basement, where I found what I expected to find: dirty pans, rancid butter, spoiled wine, unwashed linens, and a host of other calamities that I would never tolerate at the Establishment.
“Who is in charge of this place?” I demanded of Goodfellow, whirling around on him so violently that he actually took several steps away from me.
“Why, Mr. Mitchell is our superintendent,” he replied in a startled tone. “He is also waiting for you upstairs.”
I nodded. “I certainly wish to meet with him.”
Goodfellow recovered enough to make an impatient sound. “Yes, Miss Nightingale, as I had intended when you first arrived.”
We went up two flights of stairs and ended up in a large room in one of the magnificent windowed wings of the building. Around a long oak table sat six of Goodfellow’s colleagues, seated in tufted leather chairs. All of them were dressed in fine gentlemen’s clothing.
Even as Goodfellow introduced each of them, I immediately forgot their names, so blindingly angry was I. They all gazed at me curiously, and I realized I was still wearing my plain work dress instead of something finer for meeting with gentleman physicians. But I believed us at this point to be far beyond concern for elegant attire.
“Miss Nightingale,” began one of the physicians, leaning forward on the table, his fingers steepled together. “You probably saw the distressing condition of the creatures out on the lawn. We have asked you here to assist us with caring for these cholera victims, as we are certain there will be more and more cases, and we have no room for what we have.”
They all looked at me expectantly. I did not give them what they anticipated. “You do indeed have a terrible situation here, and I know that I can personally bring at least two more cholera victims to this hospital. However, I would not permit a feral dog to live here, much less an ailing person. I have several conditions that must be met before I—or any of my nurses—can assist you.”
Six pairs of jaws dropped in unison. Poor Dr. Goodfellow seemed particularly confused. No doubt I was coming across as a hysterical mental patient.
“Miss Nightingale, we are merely seeking assistance in nursing care for this unfortunate outbreak. It is well known that you are training nurses to be more than cold compress holders, and we would like to bring that expertise here,” he explained.
The doctor did seem a kind man, so it stabbed my conscience to be so prickly with him, but the conditions in this hospital were horrendous.
“I appreciate your desire to care for the sick, but I believe the current conditions of this facility will lead people to perish more readily from a stay in one of your beds than from wasting away at home with cholera.” I sat back against the leather.
Another man, who had to be reintroduced to me as Mr. Mitchell, Middlesex Hospital’s superintendent, found his voice and challenged me. “Miss Nightingale, our hospital has been in existence in this location since 1757. Why, the foundation stone was laid by our first president, the Earl of Northumberland, and we were the first hospital in England to have lying-in beds. In fact, this location began as a sixty-four-bed hospital, caring solely for sick, lame, and lying-in women of Soho.” Mitchell began ticking off his points on the fingers of one hand. “We opened a special ward for sick French clergy who had escaped their revolution back in ’96. We had the first endowment for a cancer ward more than fifty years ago. Six years ago, we added a third floor and two wings, and we now have two hundred and forty beds. We have treated thousands upon thousands of the sick and lame. My point, dear lady, is that we are a highly respectable hospital, not some tawdry boarding house.”
There was silence in the room, with the hospital’s doctors and administrators nodding in agreement with Mitchell. Goodfellow spoke up again. “This is a bit exasperating, Miss Nightingale. After all, as Mr. Mitchell says, we are a highly regarded hospital. Nonetheless, we have recognized that we need a little help to overcome this temporary crisis. Your outburst seems most unnecessary.”
I had no ar
gument with Middlesex’s past, nor with what it purported to have achieved. I objected to the condition of it today. However, there was no point in squabbling about it.
I rose from my chair and took a deep breath as I once again folded my hands together. “Gentlemen, I will return tomorrow to meet with your nurses and orderlies. Until then, I wish the following to be done.” Now I was the one to tick things off. “First, all—and I do mean all—of the windows in each ward must be thrown open to air the place out.”
Mitchell huffed his disagreement. “Preposterous. It is well established that the sick must be kept confined and not exposed to any outside air containing vapors.”
I pressed my lips together. “Sir, you have called me here because of your respect for my ways, is that not correct?”
“Well, yes, but—”
“Then I am sharing with you the manner in which I have found it best to ensure that a hospital inmate recuperates fully. Fresh air is better than stale air, even at the risk of miasmas.” I began enumerating my demands once more. “Your orderlies must remove all the slops from the water closets and from any chamber pots next to beds. All bedding must be laundered, preferably by chloride of lime dissolved in water to ensure they are well bleached. The kitchen larder must be emptied of all its food, every bit of it, and new purchased in its place. I will provide you with a list of foodstuffs to procure, but be assured it will center upon eggs, meat, tea, and quality wines.”
“Miss Nightingale!” Goodfellow exclaimed. His consternation was evident in his voice and on his face. “Have you no idea what that would cost? Many of our inmates cannot afford admission here whatsoever, and we have to rely on our generous donors for money. Imagine our having to go back to them to ask for additional donation because we chose to dispose of all of our food in the midst of a crisis!”
I ignored his plea. “Also, the supplies in this hospital are maintained in an utter jumble and there aren’t enough basic necessities kept on hand. I will make a list—on second thought, my nurses and I will return to put things in proper order and we will purchase supplies ourselves. You may reimburse me for them.”
The men around the table said nothing, but I saw one man pull a small leather journal from the pocket of his vest and begin taking notes. I had no idea if he would remember my instructions accurately—how much better it would have been if Mary had been with me—but his action meant he was at least taking me seriously.
I spent some time outside with the poor souls suffering on the lawn before leaving, doing my best to comfort them and assure them that they would receive the best care possible, even while knowing that cholera was a harsh jailer. I wasn’t sure how much effect I could have upon this hospital.
The one thing I knew for sure was that Middlesex Hospital itself would have to be cured before it could be expected to treat the desperately sick.
* * *
Nurses Harris and Lambert, Mary Clarke, and I returned to Soho later via a hired wagon. We four sat on a bench running along one side of the interior of the wagon, surrounded by fresh linens, freshly pumped water in bottles, gallons of bone broth, and a plethora of rags and cleaning supplies.
I had to offer our driver a king’s ransom not only to take us all the way to Seven Dials, but also to sit and wait for us. He was very tetchy about it, but I finally named a price that would have bought him a suit of clothes and fed his family for a month, and so he agreed.
As we made the jarring ride into Soho, I gave my nurses what I hoped was an inspiring speech: “I’m sure you have heard many things about this part of London. I admit some of it is true, and the residents there are not like the middling-class women you have been used to treating at the Establishment. Yet it is our great duty to help these unfortunates, to go where they are and offer them comfort. We shall be brave and fearless and will not count the cost to ourselves. Remember that the Lord says it is more blessed to give than to receive, and give we will.”
Lambert nodded, the untied strings of her cap dancing as her head moved. Today she wore a pale-yellow head covering that reminded me of an old medieval wimple. It did effectively cover much of her birthmark and reminded me of the nuns I had met while training at Pastor Fliedner’s deaconess training center. The nuns there were compassionate and ruthlessly efficient, and I planned that Nurse Lambert would one day resemble one of Fliedner’s nuns not only physically, but in her abilities too.
“Miss Nightingale, we will do as you say, but do you think it possible that we will have cholera ourselves by the end of the day?” Lambert gazed at me steadily, her quivering lower lip the only sign that beneath her courage lay the fear of a young woman who had not yet done much in life and desperately wished to do so.
Thus far, Mary and I had shown no signs of it, but sometimes diseases had a habit of erupting when least expected. I wanted to encourage her but did not wish to be overly optimistic. “Whatever is to happen, we will face it together, nurse. And we have the added benefit of one another, and who knows how to care for the sick better than the nurses of the Establishment?”
Nurse Harris clasped Lambert’s hand in her own in support and nodded once at me as if to let me know she understood and agreed. The woman was quiet and solid, standing like a piece of granite in a hurricane. I envisioned her one day running the Establishment or some other hospital herself.
By the time we reached the Reeves’, tragedy had already struck, and the devil himself must have had a hand in it. We discovered from a neighbor lounging around outside, who spoke broken English with a heavy Italian accent, that the family was no longer there and for the worst reason imaginable: Mr. Reeve had returned home the previous evening and done in his poor wife for unintentionally killing their daughter. First had come a tempestuous, one-sided argument by the husband. Then, the neighbor said, the woman’s screams could be heard up and down the street before he silenced her with a slam of her head against their crumbling fireplace.
The young boy, Lucky, had last been seen running down the street as though he had a demon on his heels, and I suppose in some ways he had. He hadn’t been heard from since.
Mary sniffed and put a hand to her mouth. “Poor mite,” she whispered.
Mr. Reeve had left the house in a rage, although not in the same direction his son had gone, and several nearby men had entered the lodgings. One of the men had instantly assessed what had happened when he saw poor Mrs. Reeve crumpled in a pool of blood and the long-dead girl on the bed. He had run after Reeve while some women had collected the dead bodies. He had found Reeve an hour later inside an alleyway latrine, already suffering the effects of cholera.
The woman I talked to assumed Reeve was dead, too. She smiled a mouthful of rotting teeth at the thought that Lucky’s father had received his comeuppance in so short a time and expressed her pride that she was now caring for the poor orphaned infant.
We unloaded some of the food and offered it to the woman, who fell upon it in disbelief.
I worried that the scene at the Maddox residence would not be much better, and that the ravages of cholera might seem an improvement to what we had witnessed here.
CHAPTER 9
As the wagon rumbled down the narrow, rutted street, my bones were jarred near to breaking. It was a relief when the driver had to slow down to maneuver around obstacles. As we entered Broad Street, Mary nudged me and pointed to a sign on a post freshly erected near the Lion Brewery. I had the driver stop so I could read it.
The GOVERNORS and DIRECTORS of the POOR
HEREBY GIVE NOTICE
That, with the view of affording prompt and Gratuitous assistance to Poor Persons resident in this Parish, affected with Bowel Complaints and
CHOLERA,
The following Medical Gentlemen are appointed, either of whom may be immediately applied to for Medicine and Attendance, on the occurrence of those Complaints.
Dr. John SNOW—Sackville Street
Dr. Stephen GOODFELLOW—Middlesex Hospital and Infirmary
SUGGESTIONS
AS TO FOOD, CLOTHING, & c.
Regularity in the Hours of taking Meals, which should consist of any description of wholesome Food, with the moderate use of sound Beer.
Abstinence from Spirituous Liquors.
Warm Clothing and Cleanliness of Person.
The avoidance of unnecessary exposure to Cold and Wet, and the wearing of Damp Clothes, or Wet Shoes.
Regularity in obtaining sufficient Rest and Sleep.
Cleanliness of Rooms, which should be aired by opening the Windows in the middle of each day.
For Spiritual Comfort, the Rev. Henry Whitehead of St. Luke’s Church—OLD STREET has thrown open the doors to all who seek solace and prayers.
By Order of the Board,
N. Newell
Clerk
I indicated to the driver that he could move on.
I was glad to see that the authorities had responded so quickly to this burgeoning crisis. I would have to act quickly myself to get Middlesex in order if they were going to be able to successfully treat more victims.
I would also have to perform some sort of miracle to discover who had made an attempt on Liz’s life and ended up killing the Herberts’ coachman instead. I needed it resolved so I could turn my attention to the more important matter of the cholera outbreak.
Perhaps it would be better for me to beg off or defer Sidney’s task. Surely he would understand the gravity of the situation in Soho. There were potentially hundreds—if not thousands—of lives in great danger here. Liz would remain safe—both from madmen and cholera—as long as she stayed home.
But then I thought of Joss Pagg, who had died in Liz’s stead. Didn’t he deserve justice? And what of Fenton, a cholera victim simply because he had been doing his master’s bidding? Should there not be a resolution so that his death, too, was not inconsequential?
I must have sighed aloud, for Mary silently handed me a handkerchief from her sleeve. I smiled and handed it back to her.
“I am quite fine, Goose. Just woolgathering. And here we are.” The driver had stopped in front of the Maddox home, distinguishable from every other place in its tenement housing row by the faded blue paint on the door, the remnant of a more prosperous time for the neighborhood, a time long past.
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