Angered by the presence of Open Defecation in my country even in this Millennium, I was trying to trace down the pages of history to find where we went wrong. For a country which still now boasts of the civic sense of the age old Indus Civilisation in 2500 BC for their sanitary devices and sewage systems, I was wondering where we went wrong. Was it during the Hindu Raj, Muslim Raj or the British Raj? At one point of time I thought why I should blame the administrators alone for the plight of India’s present state of affairs of sanitation. What were the people doing all the time? The condition was so grim that before the advent of the British, virtually the whole nation was defecating in the open with the exception of a few rich people who could afford to have some rudimentary method of easing themselves out in the precincts of their houses.
In my search for evidence of efforts for reforms in sanitation by the administrations in the past, I bumped on a work by the famous Lady with the Lamp- Florence Nightingale. It was the time when the British crown had taken over the country from the East India Company and had a formidable presence of British Army in India. Back home the upper class in Britain found a chance for their graduating children to get into the Indian Civil Service. On the other side it was obvious that soldiers of the British Army were mostly from the working class in British. While the elite managed to get housed in all the comfort and in cool places like Simla and Ooty, the foot soldiers had to bear the brunt of the tropical climate most of the time. Sanitation was one of the conspicuously neglected areas of public health in those times and it affected the British soldiers too.
The following literature gives a good account of Florence Nightingale’s intervention into the sanitary problems faced by the British soldiers and the Indian public:
“…..India was the responsibility of the East India Company based on the Calcutta, Bombay and Madras States surrounding these areas were either co-operative or hostile, as it suited them. If any proved troublesome the Company's private armies would move in.
In the May of 1857 the Indian Mutiny broke out. It began in the Bengal army, its immediate cause was the supply to native troops ammunition which had been greased with animal fat unacceptable to both Moslems and Hindus on religious grounds. (cow fat which upset the Hindus, or pig fat which offended Muslims). It was used as a pretext to anti-British feelings, so that when the Sepoys at Meerut rebelled against their English Officers and murdered them, the mutiny spread quickly throughout India. Mutineers marched to Delhi, and proclaimed allegiance to an elderly survivor of the old Mogul Imperial house. They surrounded Lucknow and Cawnpore. In spite of promises to spare British troops and their families who surrendered, murdered all those who did so at Cawnpore.
Order was established in the Autumn of 1858. When British Troops recaptured the towns, they took a bloody revenge. The India Act 1858, removed administration powers from the East India Company to the Crown, and incorporated the Company's troops in the British Army. The post of secretary of state for India was created, and instead of a Governor-General, there was a Vicroy.
The Secretary of State for India controlled the India Office in King Charles Street, Westminster, which acted as a communicating channel between the government in India and the government in London. It had a long history from the days of the East India Company, the Secretary of State and his officals had worked in the East India House in Leadenhall Street until it was sold in 1861. The India Office was responsible for the recruitment of officals sent out from Britain to govern India. The Indian Civil Service was the goal of ambitious university graduates, of the upper-middle class of British Society. The men who ruled India were seldom interested in India or the people who lived there. They often had a cynical and uncomplimentary opinion of those Indian they met. The Indians, too, very often preferred to keep their distance. They felt their task was to administer well, maintain order, peace and justice not to reform.
The seat of the British Government in India, was Government House Calcutta. It was built in 1803 by the fourth Governor-General Lord Wellesley. From the 1860`s the building was shuttered up for seven months of the year, while the Vicroy`s retreated 1,000 miles north-west to the cool of Simla in the Himalayas.
India was occupying Miss Nightingale's attention. There was an appallingly high mortality from sickness among British troops in India. They had to drill for hours on shadeless barrack squares in hot weather. There was little opportunity to change their uniform, the diet was also unsuitable. In 1859 the average death rate among British soldiers serving in India during the past 40 years was sixty-nine out of every thousand were dying due to poor conditions. The warrant setting up the Commission was set up on May 19th 1859. Sidney Herbert was chairman but had resigned when he became Secretary of State for war in June of the same year. There were three sanitary experts which included; Dr Alexander and Dr Sutherland, the statistician Dr Farr and two members of the India Council, who sat on the Commission. They were never to go to India, but collected information over great distances.
Miss Nightingale decided that she would collect as much information as possible on conditions of the army stations in India. With the change of power in India, from the East India Company, to the India Office, many of the records had not been transferred, and members of the Company were not very helpful, also Miss Nightingale could not find any useful figures, she and Dr Farr could work on. She decided to collect the information herself and she drafted a `Circular of Enquiry` which was sent to every military station in India. The questions asked related to sickness mortality, the age and length of service of each man. Also the facts on hospitals and barrack accommodation. The returned reports filled a whole room. Although Miss Nightingale had collected so much information, she was not actually a member of the Commission, and she should not be called as a witness. In October 1861 she was officially invited to submit her `Remarks` on the Station Reports. She completed her analysis in 1862 under the title of `Observations`.
Miss Nightingale had a number of her work `Observations` printed privately and she sent a copy to Queen Victoria, to Cabinet Ministers and to members of the India Council. Her statistics showed that the death rate in the British Army was 69 per 1000. They mainly died of over-crowding, lack of drainage, bad water, the climate also paid a part, also the native populations living close by in appalling filth. The barracks were of poor construction being built of loath and plaster, the floors of earth, varnished over with cow dung. No drainage whatever existed, and the drinking water was either described in the station reports she received as `smells good` or `smells bad`, one station sent back a chemical analysis of its water stating it was `like an intricate prescription.`
The troops had no means of recreation and no opportunities for exercise. During hot weather they had to stay in their barracks from 8am to 5pm. Hospitals were not much better, and men would conceal their illness rather than go their. Compared to the Native troops they were living in luxury. The native troops had no barracks, lavatories, baths or kitchens, and they did not receive any rations.
To improve the conditions of the Army in India posed a new problem. In England the living conditions of the Army fell well below that of the towns in which the troops were stationed. In India their conditions were already well above those of the natives. This would mean raising the sanitary conditions for the country as a whole.
The Report was published but it was not welcome. The Government was having great difficulties in India, with the transfer of authority from the East India Company to the India Office so recent, there had not been time to rectify what had been in the Report. It was also felt that the report exaggerated and the statistic incorrect.
The Clerk to the Commission prepared a shorter version of her report leaving out much of the facts her report was based on. It was the only edition on sale to the public, and presented to both Houses of Parliament. Miss Nightingale original report, of which 1,000 copies had been printed. These copies were not obtainable, and were `reserved` by the Government. Miss Nightingale's report was contained in two enormous volumes, comprising of 2028 closely printed pages.
Miss Nightingale found it absurd that the only report available for anyone to read had omitted the evidence she had collected at the instruction of the Government. So she persuaded Lord de Grey to allow her to rewrite it. Miss Nightingale persisted and finally she was allowed to proceed, it included an official preface by Lord de Grey, he recommended it to the attention of commanding medical and engineering officers.
It was now her work would begin persuading the Officials to act upon the commissions report. An official despatch was sent to India, suggesting the formation of sanitary commissions in each Presidency. Also that two additional members to represent India were added to the Barrack and Hospital Improvement Commission. These suggestions met with an out cry from officials in the India Office and in the War Office. They still would not accept the details of the Commissions report stating that it was not correct and out of date. Her work had come to a temporary halt.
In 1863, Sir John Lawrence took over as Viceroy after the death of Lord Elgin. Miss Nightingale knew him well and felt that once again she could continue with her work in India. She had never been to India, her knowledge had been gained by her work on the Station Reports, but she was consulted by men who had lived there all their working lives. Lord Stanley had requested that Sir John Lawrence should speak to Miss Nightingale about sanitary reform in India, he did so, on December 4th 1863, a week before he was to leave for India. The meeting was a success, and she was to send out full statements and schemes of what the Presidency Commissions were to do. Lord de Grey asked her to draft an official document from the War Office to the India Office enquiring what steps they proposed to take to carry out the recommendations of the Indian Sanitary Commission.
In January 1864 Miss Nightingale with Dr Sutherland, Dr Farr and Sir Robert Rawlinson completed `Suggestions in regard to Sanitary Works required for the Improvement of Indian Stations`. It was the first sanitary code for India, giving details of water supply, drainage, sanitation, hospital and barrack construction. The report was sent to the War Office. Sir John Lawrence had written asking what had become of the report, all she could reply was it had been sent to the War Office. There had been a delay because the War Office and the India Office had fallen out. The India Office would not accept the recommendations given by the War Office on the Indian Sanitary Commission. The Vicroy was willing and had already set up the Presidency Sanitary Commissions but they were unable to do anything until they received the Governments instructions for action contained the `Suggestions.` The conflict between the two offices was solved by a phrase on the title page. Although the Indian Sanitary Commissi9on had been a War Office Commission, the title page stated that the `Suggestions` had been `prepared by the said Commission in accordance with letters from the Secretary of State for India in Council`. Miss Nightingale then set about having copies printed at her own expense.
With the help of the Commander-in-Chief, Sir Hugh Rose, sanitary work in the army was soon under way. He had been contacted about the recommendations in the Indian Sanitary Report which affected regiments. He had agreed with the report and acted immediately. Recreation rooms and workshops were opened, gardens were laid out to provide troops vegetable. Libraries, savings banks and courses of instruction in trades started. Drinking was reduced, by cutting the ration and prohibiting the sale of liquor near the barracks, if caught it would incur a heavy fine.
Although Sir John Lawrence was a success personally with Miss Nightingale, he was not a success as a Vicroy. Financially and administratively India was in disorder, mainly due to the increase in military expenditure. Sir Hugh Rose had achieved a great deal for the army, all other plans were getting no where. Also the Sanitary Commissions set up in the Presidencies were secondary to their local Government.
Mr Ellis a friend of Sir John Lawrence had returned to England in 1865 to study sanitary works. He stayed with Miss Nightingale, and she arranged for Dr Sutherland to accompany him to barracks, hospitals and institutions.
Sir Charles Wood secretary of State for India resigned, and was succeeded by Lord de Grey, he was on Miss Nightingale's side for her reforms. All was not well as the Government fell in June 1866, Lord de Grey was out of office. In the months before the Government fell she had been working on a plan for a public health service in India, one again she had been defeated, and now felt her influence in the Government was now over. Lord de Grey was succeeded by Lord Cranborne. Before Lord Cranborne could do anything about India he resigned, and Sir Stafford Northcote took over, he was unknown to Miss Nightingale. Sir Bartle Frere, and Indian administrator, had been appointed to a seat on the India Council after being Governor of Bombay. He had been anxious to talk with Miss Nightingale which he did and they were to become close friends. For the next two months they were to meet almost daily, and she learnt a lot from him of life in India.
Miss Nightingale wrote to Sir Stafford Northcote about the importance of establishment of an Indian public-health service. It was important that she should impress him and get him on her side, as he may be her last chance. On August 20th 1867, He called at South Street, she felt the meeting was a success. He came to see her again in October, they agreed on the names for the members of the Indian Sanitary Committee, the Committee was to act only on a consultative capacity. He asked her to draft an answer to a despatch received from the Government of India relating to the appointment and pay of medical officers, also for her to prepare a summary of the progress of the whole Indian Sanitary question from the setting up of the Sanitary Commission in 1859 to 1867. The despatch was sent, reports were received from the Presidencies which were printed as a Blue Book in 1868 under the title of the India Office Sanitary Annual, together with Miss Nightingales summary of the Indian sanitary question, her memorandum on it and a copy of the despatch itself. At last she had accomplished something, she had secured a Sanitary Department in the India Office.
When the Annual Reports of the Sanitary Departments were received they were directed to her. Dr Hathaway the private secretary to the Vicroy, Dr Hewlett, sanitary officer for Bombay, Dr Cummingham, sanitary advisor to the Government of India, all corresponded with her and became friends. She was called on by Mr Ellis, President of the Madras Sanitary Commission, Dr Walker, and Mr John Strachey, the first President of the Bengal Sanitary Commission. In 1870 she was selected as an honorary member of the Bengal Social Science Association. Lord Napier, an old friend of Miss Nightingale had been appointed, in 1865, Governor of Madras. He had made many changes roads, schools, drainage and irrigation. Under the direction of Lady Napier, female nurses had gradually introduced into Indian hospitals.
During 1864, Miss Nightingale and Douglas Galton had been working on plans for a model barrack in India. A single plan would not do as the climate was very different throughout the Country. So she defined the essential features which each barrack should have. It would be up to local authorities to adapt them to local conditions. A grant of seven million was given, and work began at once. The work was to be carried out by the Royal Engineers, they were determined to build the barracks without any influence, or advice from civilians. They produced standard plans, to be used all over India. Disaster followed when the troops moved in. Cholera broke out in the new barracks at Allahabad, Lucknow, Morar and Jullundur. Many men were moved back to the old barracks. Those who approved of sanitary reform in the War Office were now beginning to doubt the need for it. Lord Mayo wrote to Miss Nightingale in 1870 about the failure of the barracks, and she felt that her influence over him may be weakening. Sadly in 1872, while Lord Mayo was inspecting a penal settlement he was killed by a convict. He was succeeded by Lord Northbrook.
In 1877 famine hit the Presidencies of Bombay and Madras. The following year a committee was set up to find a way of preventing famine in the future, by constructing irrigation works. Miss Nightingale had spoken to Sir Arthur Cotton three years earlier about his irrigation work. He had irrigated Trichinopoly and Sout Arcot in Southern India, by building two dams across the river Coleroon, and these areas had not suffered loss of life during the famine. The Government of India would not agree to large scale irrigation as it would be too costly.
In July 1883, Miss Nightingale wrote to the Queen about the `Ilbert` Bill which gave increased powers to native magistrates. Since 1858 Indians had been allowed to enter the Civil Service and in spite of the fact that promotion was by no means made easy, certain of them reached the rank of District Magistrate, yet because Englishmen could be tried only by English magistrates, an Indian District Magistrate could find himself without authority to try cases which were within the authority of his subordinates. Later that month Miss Nightingale forwarded some figures with deepest reverence and highest hopes `for all the great measures by which the Viceroy is bringing peace to the people of India and fulfilling England's pledges, and the love and blessing of India's people be upon him!` Miss Nightingale helped Lord Ripon on Indian affairs and acted as a reference library for him. Lord Roberts became the new Commander in Chief in 1881, a scheme was introduced to all candidates for the Indian Civil Service. This was to include one years study at University to include agriculture, chemistry, botany, geology, forestry and animal physiology. The lecturer was Sir George Campbell.
The Ilbert Bill was passed in January 1884. The situation in India gave Miss Nightingale reasonable grounds for hope. Unexpectedly Lord Ripon resigned, his term of office had not expired. So great was the personal animosity against him that he considered his best course was to secure a suitable successor and go home.
With co-operation of Lord Roberts she obtained official sanction for the employment of female nurses in the military hospitals in India, at Umballa and Rawalpindi. Lord Roberts also established a soldiers club or a regimental institute in every station in India, opened coffee houses and founded an Army Temperance Association.
Her final crusade for the people of India began in 1891, when she was seventy-one. The People were poor, without proper sanitation they would not have a good water supply. As they were not fit to work, how could they pay the extra taxation to provide the necessary work under the Bombay Sanitation Act. She set out a plan for a new taxation system, which she set out in a memorandum. It was signed by Douglas Galton and other sanitary experts, and was sent to the Secretary for State for India, who then forwarded it to the Vicroy Lord Lansdowne. In 1894 she received an answer, the Government of India could not accept her suggestion, but would press the claim of sanitation upon local governments and administrators as opportunity offered. This was Miss Nightingale’s final active work in India, but still continued in an advisory capacity.”
Despite so much of effort to usher a new thinking about sanitation and public health in India, the fact ,sadly, remains that, Florence Nightingale had never visited India. I felt very sad when I came to know that she had done so much for India without visiting the country.
As a post script, I would like to end with the thought that if only the Lady with the Lamp had stepped on the Indian soil, the plight of Sanitation in India would not have been so bad as we see it today. The forthrightness with which she could convince the British Crown on the status of sanitation in India is amazing. The honesty of her massive work and the chivalry of her work execution could have been used in a better way if she had just made a visit to India at that point of time during her study or even after that.
P.Uday Shankar
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