Florence Nightingale I

Nightingale—1 Florence Nightingale I. Bernard Cohen Scientific American 250(3):128-137, March 1984. lorence Nightingale is remem- ured and subjected to mathematical nursing, her father took that interest bered as a pioneer of nursing analysis. seriously enough to consult with physi- and a reformer of hospitals. She cians about the suitability of such a Nightingale’s achievements are all Fherself saw her mission in larger terms: career. the more impressive when they are to serve humanity through the preven- gauged against the background of so- If pursuing any career was a radical tion of needless illness and death. For cial restraints on women in Victorian step for a woman of Nightingale’s so- much of her long life (1820-1910) she England. Her father, William Edward cial class, however, taking up nursing pursued this mission with a fierce de- Nightingale, was an extremely wealthy seemed out of the question even in her termination that gave everything she landowner, and the family moved in the enlightened family. It was not “the did a singular coherence. Her greatest highest circles of English society. In physically revolting part of a hospital” contributions were undoubtedly her those days women of Nightingale’s that offended William Nightingale so efforts to reform the British military class did not attend universities and did much as what seemed to be over- health-care system and her establish- not pursue professional careers; their whelming evidence of the dissolute ment, through the founding of training purpose in life was to marry and bear habits of nurses. Nurses in those days programs and the definition of sound children. Nightingale was fortunate: her lacked training they were almost al- professional standards, of nursing as a father believed women should be edu- ways coarse and ignorant women, respected profession. Much of what cated, and he personally taught her given to promiscuity and drunkenness. now seems basic in modern health care Italian, Latin, Greek, philosophy, his- Nightingale herself later told her father can be traced to pitched battles fought tory and— most unusual of all for she had been informed by the head by Nightingale in the 19th century. Less women of the time—writing and nurse in a London hospital that she well known, because it has been ne- mathematics. When in her early twen- “had never known a nurse who was not glected by her biographers, is her ties Nightingale expressed an interest in drunken” and that most of the nurses equally pioneering use of the new ad- vanced techniques of statistical analysis in those battles. Nightingale learned at first hand as chief nurse during the Crimean War (1854-56) that improved sanitary conditions in military hospitals and barracks could sharply cut the death rate and save thousands of lives. Her battle was to convince skeptical men in power. At a time when the collection and analysis of social statistics was still uncommon Nightingale recognized that reliable data on the incidence of pre- ventable deaths in the military made compelling arguments for reform. Thus in addition to advancing the cause of medical reform itself she helped to pioneer the revolutionary notion that social phenomena could be objectively meas- Polar-area diagram invented by Florence Nightingale. Nightingale—2 engaged in “immoral conduct” with the family, she served an apprenticeship at dages” but also there was not a single patients in the wards, not surprisingly, another hospital, this one operated by qualified nurse in the British military her parents hoped their daughter would the Sisters of Mercy in St. Germain, hospital at Scutari (near Constantin- give up her unusual ambition, marry near Paris. At the age of 33 she was at ople). The French, on the other hand, and settle down. last starting out in her chosen profes- had sent 50 Sisters of Mercy to the sion. Crimea. y all accounts Florence Nightingale was an attractive Returning to London in 1853, t was a golden opportunity for young woman, and it was not Nightingale soon got her first “situa- the ambitious Nightingale. She Bfor lack of opportunity that she rejected tion” (an unpaid one) as superintendent immediately wrote to a longtime marriage. Indeed, she once was of a London “establishment for gentle- Ifriend, Sidney Herbert, the “Secretary tempted to accept a suitor, but after a women during illness.” Her job was to at War,” to volunteer her services. As it long courtship she reluctantly con- supervise the nurses and the function- happened, a letter from Herbert was cluded that she could never satisfy her ing of the physical plant and to guar- already on its way to her, asking her to “moral” and “active” nature “by antee the purity of the medicines. Al- recruit a corps of trained nurses and spending a life with him in making though she succeeded in creating a lead them to Scutari. When Nightingale society and arranging domestic things.” model institution by the standards of left for Turkey on October 21, 1854, Conventional marriage, she wrote in the day, one that was open to patients accompanied by 38 nurses, she had the her diary, meant “to be nailed to a con- of all classes and religions, she was official backing of the government (al- tinuation and exaggeration” of her disappointed that she could not accom- though not of the army) and, perhaps “present life,” a prospect that seemed to plish what even then she had come to more important, the private financial he “like suicide.” God, she decided, consider her primary aim: the estab- support of a special fund raised by The had envisioned for her a different fate. lishment of a formal training school for Times. Besides making her an interna- She was one of those whom he “had nurses. tional heroine, her work in the Crimea clearly marked out…to be single and the conditions she saw there were Nightingale stayed only a year at her women.” to determine her mission for the rest of first job, because greater opportunities her life. When her parents forbade her to take awaited her. In September, 1854, Brit- up nursing, Nightingale turned for com- ish and French troops invaded the Cri- The conditions Nightingale and her fort to religion. It was to remain a mea, on the north coast of the Black party found when they arrived at Scu- driving force in her life. Her religious Sea, in support of Turkey in its dispute tari on November 5, the day of the feelings, however, centered on the con- with Russia. (Russia had long had ter- major Battle of Inkerman, were ap- viction that the best way to serve God ritorial ambitions in Turkey, particu- palling. The hospital barracks was in- was through service to mankind. Thus larly with regard to Constantinople, the fested with fleas and rats. Under the in the difficult years of her twenties she Orthodox holy city; one of the proxi- buildings, as a commission of inquiry did not give up her ambition to pursue a mate causes of the Crimean War was later reported, “were sewers. loaded career; she read voraciously on medi- the Russian demand that it be given a with filth. through which the wind cine and health care, spent some time protectorate over the Orthodox subjects blew sewer air up the pipes of numer- inspecting hospitals in London and of the Turkish sultan.) The allied forces ous open privies into the corridors and worked privately with children of the scored a quick victory at the Battle of wards where the sick were lying” on slums, whom she called her “little the Alma River on September 20, and straw mats, in a state of overcrowding thieves at Westminster.” Still, she was then began a siege of the Russian naval that got even worse after Inkerman. frustrated. base at Sevastopol. Public jubilation in The canvas sheets, according to Night- Britain soon turned to dismay when the ingale, were “so coarse that the Finally in 1851 Nightingale was able Crimean correspondent of The Times, wounded men begged to be left in their to break away from home, spending William Howard Russell, reported that blankets”; moreover, the laundry was three months near Dusseldorf in Ger- sick and wounded British soldiers were done in cold water, with the result that many at a hospital and orphanage run being left to die without medical atten- many linens returned as clean were so by a Protestant order of “deaconesses.” tion. Not only were there too few sur- “verminous” that they had to be de- Later, in spite of the protests of her geons and “not even linen to make ban- stroyed. Essential surgical and medical Nightingale—3 Diagrams from the Royal Commission's report compare conditions in the army to those in ci- vilian life. supplies were lacking, or their distribu- In her efforts to establish an effective wards. Even after she had achieved tion was blocked by military red tape. hospital in Turkey, Nightingale showed greater acceptance she had to struggle real skill as an administrator. At every against petty officials, such as a supply These were the conditions that step, however, she was hampered by officer who refused to distribute badly awaited patients arriving at Scutari af- the military authorities, who resisted needed shirts from his store until the ter a slow sea voyage across the Black any change that might seem to be a entire shipment of 27,000 could be in- Sea and through the Bosporus, weak concession of their own errors or in- spected by an official of the Board of and emaciated, suffering from frostbite competence. The military men resented Survey.

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