Florence Nightingale: Health Pioneer

FLORENCE NIGHTINGALE: a pioneer of handwashing and hygiene for health

BY RICHARD BATES

This article first appeared on The Conversation (see below)

Florence Nightingale was born in Florence, Italy on May 12, 1820. She was named in honor of her birth city. During the Crimean War, she and a team of nurses improved the unsanitary conditions at a British base hospital, reducing the death count by two-thirds. Her writings sparked worldwide health care reform. In 1860 she established St. Thomas’ Hospital and the Nightingale Training School for Nurses. She died on August 13, 1910, in London.

The trailblazing nurse published her revolutionary work on public health and hospital design during her own quarantine.

According to Joshua Hammer, author of an article in the March edition of  Smithsonian magazine, “Researchers are calling attention to her pioneering work as a statistician and as an early advocate for the modern idea that health care is a human right.”

  Florence Nightingale: Changing the Field of Nursing – Fast Facts | History

Florence Nightingale, who was born 200 years ago, is rightly famed for revolutionizing nursing. Her approach to caring for wounded soldiers and training nurses in the 19th century saved and improved countless lives. Her ideas on how to stay healthy still resonate today – as politicians give official guidance on how best to battle coronavirus.

For example, although Nightingale did not fully subscribe to the idea that many diseases are caused by specific micro-organisms known as germs until she was in her sixties, she was well aware of the importance of hand-washing. In her book Notes on Nursing (1860), she wrote: “Every nurse ought to be careful to wash her hands very frequently during the day. If her face, too, so much the better.”

Nightingale considered the home to be a crucial site for disease-preventing interventions.

During the Crimean War (1853-1856) Nightingale had implemented hand-washing and other hygiene practices in British army hospitals. This was relatively new advice, first publicized by Hungarian doctor Ignaz Semmelweis in the 1840s, who had observed the dramatic difference it made to death rates on maternity wards.

Nightingale’s attention to international medical research and developments was just one factor behind her ability to make effective interventions in public health. Like many public health experts of her age, Nightingale considered the home to be a crucial site for disease-preventing interventions. This was the place where most people contracted and suffered from infectious diseases. (The same is true today: in Wuhan’s coronavirus outbreak, around 75-80% of transmissions were reportedly in family clusters.)

Notes on Nursing was more of a public health instruction book than a nursing manual. It advised ordinary people how to maintain healthy homes – particularly women, in accordance with the world view of the time. There was straightforward advice on everything from how to avoid excessive smoke from fireplaces (don’t let the fire get too low, and don’t overwhelm it with coal) to the safest material with which to cover walls (oil paints, not wallpaper).

Nightingale strongly counseled that people open windows to maximize light and ventilation and displace “stagnant, musty and corrupt” air. And she advocated improving drainage to combat water-borne diseases like cholera and typhoid.

In her view, all domestic interiors must be kept clean. Dirty carpets and unclean furniture, she wrote with characteristic bluntness, “pollute the air just as much as if there were a dung heap in the basement”.

Good data

During her youth, Nightingale’s father had introduced her to a leading practitioner of statistics, then a new academic field, and paid for her to have a mathematics tutor. During and after the Crimean War, Nightingale seized on statistics as a way of proving the effectiveness of different interventions.

She went on to produce her famous diagrams, which demonstrated the high proportion of soldiers’ deaths caused by disease as opposed to battle wounds and became the first woman admitted to the London Statistical Society in 1858.

Thereafter she designed questionnaires to obtain data on such questions as the sanitary condition of army stations in India, or the mortality rates of the indigenous populations in Australia. Her guiding principle was that a health problem could only be effectively tackled once its dimensions were reliably established.

In 1857, around a year after returning from the Crimean War, Nightingale suffered a severe collapse, now believed to have been caused by a flu-like infection called brucellosis. For much of her subsequent life, she was racked with chronic pain, often unable to walk or leave her bed.

Working from home

Having been declared an invalid, she imposed a rule of seclusion on herself because of pain and tiredness rather than from fears of contagion – a form of self-isolation that extended to her closest family (though she still had servants and other visitors).

During her first years of working entirely from home, Nightingale’s productivity was extraordinary. As well as writing Notes on Nursing, she produced an influential 900-page report on the medical failings during the Crimean War, and a book on hospital design.

This was in addition to setting up the Nightingale Training School for nurses at St Thomas’ Hospital in London in 1860, and a midwifery training programme at King’s College Hospital in 1861, plus advising on the design of a number of new hospitals.

Later in the 1860s, Nightingale proposed reform of workhouse infirmaries to make them high-quality taxpayer-funded hospitals; and also worked on sanitary and social reforms in India. All of this she accomplished without leaving her house (though government ministers sometimes came to her home for meetings).

Having said this, it is worth remembering that Nightingale’s was a privileged form of self-isolation. Her father’s fortune, derived from Derbyshire mining interests, meant she had no money worries.

She lived in a nice house in London with various assistants and servants to help, shop and cook for her, and had no children to look after. Her entire waking time could be devoted to reading and writing.

So while this is an appropriate time to recall and celebrate the huge contribution Nightingale made to modern nursing and public health care, we shouldn’t feel too bad if we don’t quite live up to her high standards of isolated productivity.

This article first appeared on The Conversation  

ABOUT THE AUTHOR –  Richard Bates

Richard Bates is a Postdoctoral Research Fellow at the Department of History, University of Nottingham. He works on the project ‘Florence Nightingale Comes Home for 2020’ (www.florencenightingale.org) at the University of Nottingham, headed by Professor Paul Crawford and Dr. Anna Greenwood, funded by the Arts and Humanities Research Council. View the full list

If you enjoyed this article, see more from GRAND – Maya Angelo

More on Florence Nightingale

According to Brigit Katz, a writer for Smithsonianmag.com, “In 1854, Florence Nightingale arrived at a military hospital in Scutari, near Constantinople, to tend British soldiers wounded during the Crimean War. Appalled by the conditions—rodents and vermin running rampant, patients lying in their own filth, a woeful lack of basic medical supplies—she quickly set about implementing reforms. Nightingale was a tireless nurse; at night, she would wander the darkened rooms of the hospital, checking on patients by lamplight. Her admirers took to calling her the “Lady with the Lamp.”

The image of Nightingale ministering to the sick, her trusty light in hand, became iconic in her native Great Britain, appearing in paintings and on a £10 note released in 1975. But the lamp she actually carried was different than the spouted devices that often appear in her portraits: In reality, Nightingale relied on a folded Turkish lantern, or fanoos, to illuminate her patients.

The nursing pioneer’s original lantern is among 200 objects set to go on view at the Florence Nightingale Museum in London as part of a new exhibition celebrating the bicentenary of her birth.

In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.

Death and Legacy

In August 1910, Florence Nightingale fell ill but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her home in London.

Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. The “Lady with the Lamp” was laid to rest in a family plot at Westminster Abbey.

The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the “Angel of the Crimea.” To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing.

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Most people know Florence Nightingale was a compassionate and legendary nurse, but they don’t know her full story. This riveting biography explores the exceptional life of a woman who defied the stifling conventions of Victorian society to pursue what was considered an undesirable vocation. She is best known for her work during the Crimean War, when she vastly improved gruesome and deadly conditions and made nightly rounds to visit patients, becoming known around the world as the Lady with the Lamp. Her tireless and inspiring work continued after the war, and her modern methods in nursing became the defining standards still used today. Includes notes, bibliography, and index. Buy/$12.55

Florence Nightingale Biography – History.com

Early Life

Florence Nightingale was the younger of two children. Nightingale’s affluent British family belonged to elite social circles. Her mother, Frances Nightingale, hailed from a family of merchants and took pride in socializing with people of prominent social standing. Despite her mother’s interest in social climbing, Florence herself was reportedly awkward in social situations. She preferred to avoid being the center of attention whenever possible. Strong-willed, Florence often butted heads with her mother, whom she viewed as overly controlling.

Florence’s father was William Shore Nightingale, a wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in Hampshire, Embley Park—when Florence was five years old. Florence was raised on the family estate at Lea Hurst, where her father provided her with a classical education, including studies in German, French and Italian.

From a very young age, Florence Nightingale was active in philanthropy, ministering to the ill and poor people in the village neighboring her family’s estate. By the time she was 16 years old, it was clear to her that nursing was her calling. She believed it to be her divine purpose.

When Nightingale approached her parents and told them about her ambitions to become a nurse, they were not pleased. In fact, her parents forbade her to pursue nursing. During the Victorian Era, a young lady of Nightingale’s social stature was expected to marry a man of means—not take up a job that was viewed as lowly menial labor by the upper social classes. When Nightingale was 17 years old, she refused a marriage proposal from a “suitable” gentleman, Richard Monckton Milnes. Nightingale explained her reason for turning him down, saying that while he stimulated her intellectually and romantically, her “moral…active nature…requires satisfaction, and that would not find it in this life.” Determined to pursue her true calling despite her parents’ objections, in 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany.

Career

In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendant within just a year of being hired. The position proved challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenge of her nursing career presented itself.

In October of 1853, the Crimean War broke out. The British Empire was at war against the Russian Empire for control of the Ottoman Empire. Thousands of British soldiers were sent to the Black Sea, where supplies quickly dwindled. By 1854, no fewer than 18,000 soldiers had been admitted into military hospitals.

At the time, there were no female nurses stationed at hospitals in the Crimea. The poor reputation of past female nurses had led the war office to avoid hiring more. But, after the Battle of Alma, England was in an uproar about the neglect of their ill and injured soldiers, who not only lacked sufficient medical attention due to hospitals being horribly understaffed but also languished in appallingly unsanitary and inhumane conditions.

In late 1854, Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize a corps of nurses to tend to the sick and fallen soldiers in the Crimea. Nightingale rose to her calling. She quickly assembled a team of 34 nurses from a variety of religious orders and sailed with them to the Crimea just a few days later.

Although they had been warned of the horrid conditions there, nothing could have prepared Nightingale and her nurses for what they saw when they arrived at Scutari, the British base hospital in Constantinople. The hospital sat on top of a large cesspool, which contaminated the water and the hospital building itself. Patients lay on in their own excrement on stretchers strewn throughout the hallways. Rodents and bugs scurried past them. The most basic supplies, such as bandages and soap, grew increasingly scarce as the number of ill and wounded steadily increased. Even the water needed to be rationed. More soldiers were dying from infectious diseases like typhoid and cholera than from injuries incurred in battle.

The no-nonsense Nightingale quickly set to work. She procured hundreds of scrub brushes and asked the least infirm patients to scrub the inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while making her rounds, ministering to patient after patient. The soldiers, who were both moved and comforted by her endless supply of compassion, took to calling her “the Lady with the Lamp.” Others simply called her “the Angel of the Crimea.” Her work reduced the hospital’s death rate by two-thirds.

In addition to vastly improving the sanitary conditions of the hospital, Nightingale created a number of patient services that contributed to improving the quality of their hospital stay. She instituted the creation of an “invalid’s kitchen” where appealing food for patients with special dietary requirements was cooked. She established a laundry so that patients would have clean linens. She also instituted a classroom and a library, for patients’ intellectual stimulation and entertainment. Based on her observations in the Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. The book would spark a total restructuring of the War Office’s administrative department, including the establishment of a Royal Commission for the Health of the Army in 1857.

Nightingale remained at Scutari for a year and a half. She left in the summer of 1856, once the Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her surprise, she was met with a hero’s welcome, which the humble nurse did her best to avoid. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government.

Nightingale decided to use the money to further her cause. In 1860, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. Nightingale became a figure of public admiration. Poems, songs, and plays were written and dedicated in the heroine’s honor. Young women aspired to be like her. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was no longer frowned upon by the upper classes; it had, in fact, come to be viewed as an honorable vocation.

Later Life

While at Scutari, Nightingale had contracted “Crimean fever” and would never fully recover. By the time she was 38 years old, she was homebound and bedridden and would be so for the remainder of her life. Fiercely determined, and dedicated as ever to improving health care and alleviating patients’ suffering, Nightingale continued her work from her bed.

Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published Notes on Hospitals, which focused on how to properly run civilian hospitals.

Throughout the U.S. Civil War, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and civilians, although she had never been to India herself.

In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.

Death and Legacy

In August 1910, Florence Nightingale fell ill but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 pm the following day, Saturday, August 13, at her home in London.

Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. The “Lady with the Lamp” was laid to rest in a family plot at Westminster Abbey.

The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the “Angel of the Crimea.” To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing.

Biography courtesy of History.com