Portraits of Celebrated Women (Clark)/Chapter 8
VIII.
AN ANGEL OF MERCY—FLORENCE NIGHTINGALE.
The most barren desert is not without its oasis, where the green grass springs up and the flowers blossom. Nor is there any region so girt with ice and sand, that its desolation is unrelieved by the lichen clinging to its native rock and greeting the eye with its verdure. So the darkest scenes of human history are often relieved by the revelation of some angel of mercy and love, commissioned for deeds that warm the heart with holy admiration. This gives us hope of our humanity, even in its darkest and most forbidding forms. The scenes of the Crimean war in 1854 and 1855 are thus relieved by the heroic and philanthropic devotion of one whose name will live, enrolled upon the bright page of the world's benefactors, long after the illustrious generals who led in the conflict have been forgotten. The death-defying charge upon the field of Balaklava has not more certainly become "storied" in the world's history than have the philanthropy and heroism of Florence Nightingale.
Miss Nightingale was born, according to the best authority we have seen, at Florence in the year 1823. She received her Christian name from that renowned and beautiful Italian city. She was the youngest daughter of Mr. William Shore Nightingale, of Embley Park, Hampshire, and the Lea Hurst, Derbyshire, in England. She was a young lady of singular endowments, both natural and acquired. She early acquired a knowledge of the ancient languages, and of the higher branches of mathematics; while her attainments in general art, science, and literature were of no common order. Her command of modern languages was extensive, and she spoke French, German, and Italian fluently as her native English. She has visited and studied the various nations of Europe, and has ascended the Nile to its farthest cataract. While in Egypt she tended the sick Arabs with whom she came in contact; and it was frequently in her power, by judicious advice, to render them important services. Graceful, feminine, rich, and popular, her influence over those with whom she came in contact was powerful as it was gentle and persuasive. Her friends and acquaintances embraced a large circle, and included persons of all classes and persuasions; but her happiest place has ever been her home, where, in the center of numerous and distinguished relatives, and in the simplest obedience to her admiring parents, she dwelt. Her personal appearance is described by Mr. Trenery in his Crescent City, as he saw her engaged in her mission of mercy. He says she is one of those whom God forms for great ends. You can not hear her say a few sentences, nor even look at her, without feeling that she is an extraordinary being. Simple, intellectual, sweet, full of love and benevolence, innocent—she is a fascinating and perfect woman. She is tall and pale. Her face is exceedingly lovely; but better than all is the soul's glory that shines through every feature so exultingly. Nothing can be sweeter than her smile. It is like a sunny day in Summer; and more of holiness than is expressed in her countenance one does not often meet on a human face as one passes along the dusty highways of life. Through all her movements breathes that high intellectual calm which is God's own patent of nobility, and is the true seal of the most glorious aristocracy—that of mind, of soul!
From infancy she had a yearning affection for her kind—a sympathy with the weak, the oppressed, the destitute, the suffering, and the desolate. The schools and the poor around Lea Hurst and Embley first saw and felt her as a visitor, teacher, consoler, and expounder. Then she frequented and studied the schools, hospitals, and reformatory institutions of London, Edinburgh, and the continent. It appears by her evidence lately given before the English Army Medical Reform Commission, that she has devoted her attention to the organization of hospitals for thirteen years, during which time she has visited all the hospitals of London, Edinburgh, and Dublin; many country infirmaries, and some of the military and naval hospitals in England; all the hospitals in Paris, where she studied with the Sisters of Charity; the institution of the Protestant Deaconesses at Kaiserwerth, on the Rhine, where she was twice in training as a nurse; the hospitals at Berlin, and many others in Germany, and at Lyons, Brussels, Rome, Constantinople, and Alexandria; and the war hospitals of the French and Sardinians. Soon after her return home from the continent, the hospital established in London for sick governesses was about to fail for want of proper management, and Miss Nightingale consented to be placed at its head. Derbyshire and Hampshire were exchanged for the narrow, dreary establishment in Harley-street, to which she devoted the whole of her time and her fortune. While her friends missed her at assemblies, lectures, concerts, exhibitions, and all the entertainments for taste and intellect with which London in its season abounds, she whose powers could have best appreciated them was sitting beside the bed and soothing the last complaints of some poor, dying, homeless, hapless governess. Miss Nightingale found pleasure in tending these poor, destitute women in their infirmities, their sorrows, their deaths, or their recoveries. She was seldom seen out of the walls of the institution; and the few friends whom she admitted found her in the midst of nurses, letters, prescriptions, accounts, and interruptions. Her health sunk under the heavy pressure. Thus it appears she had received a special training for the great work to which she was providentially called.
When the accounts of the sufferings of the soldiery in the Crimea, of the additional rigors that they were enduring from want of effectual hospital treatment, and from defective management in supplying stores and necessary relief, she kindled at once with an enthusiastic desire to remedy the evil. The extent of that evil may be gathered from the first that there was, in the first seven months of the Crimean campaign, a mortality among the troops of sixty per cent. per annum from disease alone—a rate which exceeds that of the great plague of London, and a higher ratio than the mortality in cholera to the attacks. One of the chief points in which the deficiency of proper comfort and relief for the sick and wounded sufferers was felt, was the want of good nursing. To send out a band of skillful nurses was soon found to be one of the most essential of all supplies. But unless these were really skilled, more harm than good would certainly accrue; zeal, without experience, could effect little; and a bevy of incompetent or ill-organized nurses would prove an incumbrance, instead of an assistance. Now it was that a field was opened for the wider exercise of Miss Nightingale's genius and philanthropy; and now it was that her admirable abilities were secured for this great object in view. At the request of the Right Hon. Sydney Herbert, Miss Nightingale at once accepted the proposal that she should undertake to form and control the entire nursing establishment for the British sick and wounded soldiers and sailors in the Crimea. Indeed, it is asserted, that by a strange coincidence—one of those coincidences arising out of urgent necessity felt and met at once—she had, herself, written to Mr. Herbert on the very same day, volunteering her services where they were so much needed. The task was one which involved sacrifices and responsibilities of formidable magnitude—the risk of her own life, the pang of separation from her family and friends, the certainty of encountering hardships, dangers, toils, and the constantly-recurring scene of human suffering amidst all the worst horrors of war, together with an amount of obstacle and difficulty in the carrying out of her noble work wholly incalculable. Few but would have recoiled from such a prospect; Miss Nightingale, however, met it with her own spirit of welcome for occasion to devote herself in the cause of humanity. Heroic was the firmness with which she voluntarily encountered her task; glorious was the constancy with which she persevered in and achieved it. The same force of nature which had enabled her quietly and resolutely to accumulate powers of consolation and relief for the behoof of her fellow-creatures, enabled her to persist steadily to the end, and carry out her high purpose with a success, holy as it was triumphant.
The history of her enterprise has been well written by the author of "World-Noted Women," and we shall present it in very nearly her own words, only correcting in points upon which additional light has been given, and relieving the narrative of the tedium of too minute detail. On Tuesday, the 24th of October, 1854, Miss Nightingale, accompanied by Rev. Mr. Bracebridge and his wife, and a staff of thirty-seven nurses, set out from England. On her way through France, she and her companions were received with the most respectful attention; hotel-keepers refusing payment for their accommodation, servants declining the customary fees, and all classes vying to show sympathy with their mission. On passing through the French metropolis, one of the Paris journals made a characteristic remark upon Miss Nightingale's appearance, which, coming from the source whence it did, was the extreme of intended compliment and interest. The paper observed that "her toilet was charming, and she was almost as graceful as a Parisienne." On the Friday following, Miss Nightingale and her companions embarked at Marseilles in the Vectis steamer, and, after a stormy passage, they reached Scutari on the 5th of November, just before the wounded in the action of Balaklava began to arrive. Five rooms which had been set apart for wounded general officers were, happily, unoccupied, and these were assigned to Miss Nightingale and her nurses, who, in appearance and demeanor, formed a strong contrast to the usual aspect of hospital attendants. Under such management the chaotic confusion of the vast hospital was quickly reduced to order: the wounded, before left for many hours unattended, now scarcely uttered a groan without some gentle nurse being at hand to adjust their pillow, and alleviate their discomfort; tears stood in the eyes of many a veteran while he confessed his conviction, that indeed the British soldier was cared for by his country, since ladies would leave the comforts and luxuries of home to come and tend him in his misery. Far from realizing the fears which had been entertained by officials, that this new addition to the staff of a military hospital would not work well. Miss Nightingale and her nurses were "never found in the way except to do good."
In the mean time the reports of the condition of the destitute suffering and dying soldiery had created universal sympathy in England. It produced a sort of spontaneous action. A subscription was set afoot, and in less than a fortnight the sum of £15,000 was sent into the Times office for the above purpose. The proprietors of that journal sent out a special commissioner, Mr. Macdonald, to administer this fund, from which thousands of shirts, sheets, stockings, flannels, quilted coats, and hospital utensils, besides large quantities of arrow-root, sago, sugar, tea, soap, wine, and brandy were supplied. Whenever, as after the battle of Inkermann, crowds of wounded arrived, there was feminine ministry at hand to tend them; and when medical stores failed or demand arose for articles not forthcoming, the Times commissioner supplied Miss Nightingale at once with what was needed, if it could be procured by money in the bazars or stores of Constantinople. This promptitude of Mr. Macdonald in seconding Miss Nightingale's exertions, deserves all praise; for it mainly enabled her to carry out the immediate requisites of her plan. His own excellent letters, written at the time, give a most vivid picture of the difficulties she had to contend with, in the shape of ill-contrived arrangements alone, besides other obstructions to her procedure. A rule of the service which required that articles—needed for present use—should be obtained from home through the commissariat, and a regulation which appointed that a "board" must sit upon stores already-landed, before they could be given out, will serve as instances to show what were the obstacles against which Miss Nightingale had to exert her energies of discretion and presence of mind. To comprehend the evils occasioned by such impediments, an extract from one of the nurse's letters will offer an example: "I know not what sight is more heart-rending, to witness fine-looking, strong young men worn down by exhaustion, and sinking under it, or others coming in fearfully wounded. The whole of yesterday was spent in sewing men's mattresses together, then in washing and assisting the surgeons to dress their wounds, and seeing the poor fellows made as comfortable as their circumstances would admit of after five days' confinement on board ship, during which time their wounds were not dressed. Out of the four wards committed to my charge, eleven men died in the night simply from exhaustion, which, humanly speaking, might have been stopped, could I have laid my hands on such nourishment as I know they ought to have had."
In the article of hospital clothing, the same deplorable effects resulted from the delay and confusion which existed before Miss Nightingale's remedial measures came into operation. The original supply of these articles, inadequate as it was, had long been reduced so low, that but for the purchases made with the money of the fund, and distributed through Miss Nightingale, a large proportion of the invalids must have been without a change of under-clothing, condemned to wear the tattered, filthy rags in which they were brought down from the Crimea. A washing contract existed, indeed, but it was entirely inoperative; and the consequence was, that not only the beds, but the shirts of the men were in a state foul and unwholesome beyond description. To remedy this, a house well supplied with water was engaged at the charge of the fund, close to the Barrack Hospital, where the clothing supplied by Miss Nightingale might be cleansed and dried. Her supervision had an eye for all needs; her experience had a knowledge for all that should be done; and her energy enabled her to have carried into effect that which she saw and knew ought to be effected.
In ten days after their arrival Miss Nightingale and her assistants fitted up a sort of impromptu kitchen, and from this hastily-constructed resource, eight hundred men were daily supplied with their respective needed quantities of well-cooked food, besides beef-tea in abundance. They who are acquainted with the plan of cookery pursued in barracks, where all a company's meat and vegetables are boiled in one copper, the portions belonging to messes being kept in separate nets, will know how that food is likely to suit the sickly appetite of a fevered patient, and how invaluable a system which provided the needful light diet, prepared with due quickness, as well as nicety, would be in hospital treatment. This was effected by Miss Nightingale's kitchen, even in its early operation, and it subsequently attained a degree of excellence productive of extensive benefit, scarcely to be estimated by those unacquainted with the importance of such details. Her extraordinary intelligence and capacity for organization showed itself in subordinate, as well as principal points of arrangement. In what might be called "housekeeping duties," she showed womanly accomplishment, no less than nice judgment. When the nurses were not needed at the bedsides of the sick and wounded, they were employed by her in making up needful articles of bedding and surgical requisites—such as stump-pillows for amputation cases. Not only was the laundry in excellent working order, but by the strong representation of Miss Nightingale, the dysentery wards were cleansed out, and general purification was made a diligently-regarded particular. During the first two months after her arrival, when there was no one else to act. Miss Nightingale was the real purveyor of those vast establishments—the hospitals at Scutari—providing what could not be obtained through the regular channels of the service, and especially from her kitchen, supplying comforts without which many a poor fellow would have died. Her name and benevolent services were the theme of frequent and grateful praise among the men in the trenches; and the remark was uttered that she made the barrack hospital so comfortable that the convalescents began to show a decided reluctance to leave it. Stores of shirts, flannel, socks, and a thousand other articles, which she and her nurses distributed; brandy, wine, and a variety of things, required at a moment's notice, and which could be procured from Miss Nightingale's quarters without delay or troublesome formality, rendered her the virtual purveyor for the whole of that period, during which she was avowedly the person in whose keeping rested not only the comfort, but the existence of several thousand sick and wounded soldiers. One of Mr. Macdonald's impressive sentences serves to paint the condition of the spot in which Miss Nightingale at that time drew breath. He says: "Wounds almost refuse to heal in this atmosphere; the heavy smell of pestilence can be perceived outside the very walls." In one of the last letters he wrote, before he was compelled, by failing health, to return to England, the Times commissioner bore the following earnest testimony to Miss Nightingale's excellence. It affords a beautiful picture of her in the midst of her self-imposed task of mercy and charity. These are his words: "Wherever there is disease in its most dangerous form and the hand of the spoiler distressingly nigh, there is that incomparable woman sure to be seen; her benignant presence is an influence for good comfort, even amid the struggles of expiring nature. She is a 'ministering angel,' without any exaggeration, in these hospitals; and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night, and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds. The popular instinct was not mistaken, which, when she set out from England on her mission of mercy, hailed her as a heroine; I trust that she may not earn her title to a higher though sadder appellation. No one who has observed her fragile figure and delicate health, can avoid misgivings lest these should fail. With the heart of a true woman, and the manners of a lady, accomplished and refined beyond most of her sex, she combines a surprising calmness of judgment and promptitude and decision of character. . . . I confidently assert that, but for Miss Nightingale, the people of England would scarcely, with all their solicitude, have been spared the additional pang of knowing, which they must have done, sooner or later, that their soldiers, even in hospital, had found scanty refuge and relief from the unparalleled miseries with which this war has hitherto been attended."
The difficulties of Miss Nightingale's task were not only those arising out of its own appertaining perils and sacrifices, and those which resulted from official mismanagement, but she encountered much opposition springing from professional prejudices and jealousies. On their first arriving, so far from being welcomed, the advent of the nurses was looked upon as an evil, resented as an interference, and treated with tacit, if not open discountenance. At the best they were tolerated, not encouraged. Cabals were got up, ill feeling fostered, party differences disseminated and fomented. Passive resistance in every shape was resorted to, to prevent the installing of the nurses in the military hospitals. Against all this nothing but the exquisite tact, firmness, and good sense of Miss Nightingale could have prevailed. Having proved herself a vigorous reformer of hospital misrule, she had to encounter the tacit opposition of nearly all the principal medical officers; her nurses were sparingly resorted to, even in the barrack hospital, while in the general hospital, the headquarters of one of the chief medical authorities, she held a very insecure footing. But the return of this person to England, the continued deficiency of the purveying, and the increasing emergencies of the hospital service, enabled Miss Nightingale to extend the sphere of her usefulness; and thus, together with her own admirably patient perseverance, she succeeded in having her nurses employed in their proper posts, and her own system established in perfect working order. The results are briefly summed up. After she had introduced her system there and brought it into successful operation under her powerful will and genial presence, the mortality diminished, and during the last six mouths the mortality among the sick was not much more than among the healthy Guards at home, and during the last five months two-thirds only of what it was at home. In one sentence the world may read her devotion to her mission of army, medical, and sanitary reform: "I was never out of the hospitals," she says, "never out of the hospitals night or day."
The Hon. and Rev. Sydney Godolphin Osborne, in his deeply-interesting work upon Scutari and its hospitals, gives a description of Miss Nightingale, as she appeared exercising her vocation among the sick and dying. He says: "In appearance, she is just what you would expect in any other well-bred woman, who may have seen, perhaps, rather more than thirty years of life; her manner and countenance are prepossessing, and this without the possession of positive beauty; it is a face not easily forgotten, pleasing in its smile, with an eye betokening great self-possession, and giving, when she wishes, a quiet look of firm determination to every feature. Her general demeanor is quiet, and rather reserved; still, I am much mistaken if she is not gifted with a very lively sense of the ridiculous. In conversation, she speaks on matters of business with a grave earnestness one would not expect from her appearance. She has evidently a mind disciplined to restrain, under the principles of the action of the moment, every feeling which would interfere with it. She has trained herself to command, and learned the value of conciliation toward others, and constraint over herself. I can conceive her to be a strict disciplinarian; she throws herself into a work, as its head—as such she knows well how much success must depend upon the literal obedience to her every order. She seems to understand business thoroughly. Her nerve is wonderful; I have been with her at very severe operations; she was more than equal to the trial. She has an utter disregard of contagion. I have known her spend hours over men dying of cholera or fever. The more awful to every sense every particular case, especially if it was that of a dying man, her slight form would be seen bending over him, administering to his ease in every way in her power, and seldom quitting his side till death released him."
Delightful is that intimation that Miss Nightingale gives token of being "gifted with a lively sense of the ridiculous." Possessing the exquisite perception of the pathetic in existence which her whole career proclaims her to have, it would have been a defect in her nature, nay, a lack of the complete feeling for pathos itself, had she not betrayed a capacity for receiving humorous impressions. Humor and pathos are so nearly allied, in their source within the human heart, so mingled in those recesses whence spring human tears at the touch of sympathy, that scarcely any being deeply affected by mournful emotion, can remain insensible to the keen appeal that resides in a ludicrous idea. Shakspeare, who comprehended to perfection every impulse of humanity, affords multitudinous illustrations of this close consociation of a sense of pathos and a sense of humor in the finest natures. That particular feature chronicled by Mr. Osborne in his personal description of Miss Nightingale, is just the exquisite point, to our imagination, that crowns her admirable qualities. It accords with an intensely-beautiful account of her that was related by Mr. Sydney Herbert at a public meeting convened in Miss Nightingale's honor. He said an anecdote had been sent to him by a correspondent showing her great power over all with whom she came in contact. He read the passage from the letter, which was this: "I have just heard such a pretty account from a soldier, describing the comfort it was, even to see Florence pass. 'She would speak to one and to another, and nod and smile to as many more; we lay there by hundreds; but we could kiss her shadow as it fell, and lay our heads on the pillow again content.' What poetry there is in these men! I think I told you of another, who said: 'Before she came there was such cussin' and swearin'; and after that it was as holy as a church.' That consoling word or two, that gentle 'nod and smile' in passing, were precisely the tokens of sympathy that would come with such home-felt charm to those manly hearts from a face possessing the emotional expression which we can conceive it naturally to have, just the woman with just the countenance to exercise an almost magical moral influence over men's minds. We are told, eye-witnesses have averred, that it was singular to remark how, when men, frenzied, perhaps, by their wounds and disease, had worked themselves into a passionate refusal to submit to necessary operations, a few calm sentences of hers seemed at once to allay the storm; and the men would submit willingly to the painful ordeal they had to undergo." Noble being! Exactly that blended firmness and gentleness which makes a woman's nature so all potent in its beneficial ascendency over manhood. Rough, brave fellows, that would have resisted like iron any amount of men's persuasion, would melt at once into submission at a "few calm sentences" from those lips of hers. We can fancy the mouth, capable of smiles, or quivering with deepest feeling, compressed into resolute steadfastness, as it persuaded the men into reasonable acquiescence with what was for their good, while betraying the latent sympathy with their every pang.
Among all her anxieties, responsibilities, and more vital affairs, also, she found opportunity to attend to intellectual needs; for on one occasion, we find from a letter written in the camp before Sevastopol during the Spring of 1856, that "through the exertions of Miss Nightingale a considerable quantity of school material, such as maps and slates, was supplied to the schools." From her own stores she supplied books and games to cheer the dull hours of convalescence; and was foremost in every plan for affording the men harmless recreation. On her responsibility she advanced from the "Times Fund" the necessary sum for completing the erection of the Inkermann Cafe; she aided the active senior chaplain in establishing a library and school-room, and warmly supported him in getting up evening lectures for the men. She took an interest in their private affairs, and forwarded their little savings to their families in England at a time when there was no provision for sending home small sums; she wrote letters for the sick, took charge of bequests for the dying, and punctually forwarded these legacies of affection to relatives; she studied the comfort of those who recovered, and had a tent made to protect such of them as were permitted take the air from the searching rays of an Eastern sun—moreover, enduring the mortification of a refusal of the hospital authorities to have this tent put up. Her activity of intelligence was almost miraculous; one of its personal observers. Dr. Pincuffs, declares: "I believe that there never was a severe case of any kind that escaped her notice; and sometimes it was wonderful to see her at the bedside of a patient who had been admitted perhaps but an hour before, and of whose arrival one would hardly have supposed it possible she could already be cognizant."
Miss Nightingale would not hear of going back to England till the war was over; although her health and strength were so far impaired that when a yacht was placed at her disposal by Lord Ward to admit of her taking temporary change of air in sea excursions to recruit her for further work, she had to be carried down to the vessel carefully and reverently in the arms of the men, amidst their blessings and prayers for her speedy recovery. Her noble devotion had touched the hearts of her countrymen long before her work was completed, and the nation's gratitude could not be restrained from its eager desire to bestow some public token of acknowledgment toward a woman, who, they felt, had earned so imperative a title to their affectionate thanks. A testimonial of some sort was agreed upon as the only means of exhibiting their unanimous feeling, and of permitting every one to contribute their share in the offering. But of what was it to consist? Sums of money to a lady in affluent circumstances, would be futile; ornaments to one whose chosen sphere was by the bedside of the sick, the poor, and the dying, would be idle. Any gift to herself, who had given her most precious possessions, her time, her attentions, her sympathy to others, was not to be thought of. In the first place, it was like an attempt to reward that which was beyond reward; to pay for that which was a free donation, and, moreover. Miss Nightingale distinctly declined receiving any thing for herself. The only thing that remained, then, was to raise a fund for benevolent purposes, and to place it at her disposal, that she might approximate it according as her own philanthropic heart and admirable practical judgment should think best. Public meetings were called, presided over by a prince of the blood royal, and one who had been a personal witness of Miss Nightingale's grand work in the East; and attended by peers, members of Parliament, and some of the highest men in professional repute. They debated the question of the proposed "Nightingale Fund" in the noblest spirit of consideration—consideration for the delicate feelings of her who was the object of this testimonial of a nation's gratitude, and consideration for those who were desirous of making this public proffer of their homage. It was decided that "a fund to enable her to establish an institution for the training, sustenance, and protection of nurses and hospital attendants" would be the best form for this National testimonial to take. This determination met her cordial and heart-felt approval.
And now the time approaches when her noble duty in the East came to a close, by the declaration of peace. The date of her intended return to England was kept a profound secret, out of dread of that publicity which she has ever carefully shunned. Not only were the day and the spot of her probable landing preserved unknown, lest the popular welcome that would have greeted her arrival should take place; but desirous of maintaining the strictest incognito, she refused the offer of a passage in a British man-of-war, and embarked on board a French vessel, passing through France by night, and traveling through her own country unrecognized, till she arrived at her own home in Derbyshire, on Friday, August 15, 1856. There was one gracious welcome that Miss Nightingale could not but accept, and that was from the royal lady who was the sovereign head of the army, which had so long been the especial object of Miss Nightingale's devoted care. A visit of some days at Balmoral, where the Queen was then staying, in highland seclusion and enjoyment, was spent by Miss Nightingale in the sunshine of kindly favor; being treated, during her sojourn there, with the most marked distinction by her Majesty and every member of the royal family.
Since her return home. Miss Nightingale's name has met the public ear only in the quiet deeds of practical goodness consistent with her whole career, or in the record of patient suffering, her constitution never having recovered its tone of health. The recent accounts of her failing strength render it quite probable that, before the public shall read these pages, Mercy's Missionary will have become Heaven's Angel.
In Florence Nightingale all the world glorifies a woman who embodies the principle of devotion, in the widest sense of the word; true devoutness to God—worshiping him by best service, in benefiting her fellow-mortals, and fervent consecration of herself to a high and immortal cause.