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Florence Nightingale

Florence_NightingaleThink of caring people and you think of nurses. Think of a nurse and you think of Florence Nightingale. Think of Florence Nightingale and you think of the Lady with the Lamp. Few pictures of caring for others are so ingrained in the imagination of the Western World.

The story of Florence Nightingale is a story of personal courage, of perseverance, and of responsibility and care for those in greatest need. It is also the story of how one individual can make a difference when bureaucratic insensitivity and indifference seems to make change impossible. Such appeared to be the case with battle casualties when Britain and France went to war with Russia in 1854. The theatre of war was in southern Russia, on the Crimean peninsula, bordering the Black Sea. The wounded soldiers were, where possible, ferried to the military hospital at Scutari on the Turkish coast.

Conditions in this so-called hospital were appalling. It lacked even the most basic facilities. The lack of beds, for example, meant that the best the wounded soldiers could hope for was a to be laid on the floor wrapped in a blanket. Rats ran amongst the dying. Such was the absence of care that, on occasion, even dead bodies were forgotten about and left to rot. There were few army doctors or medical staff and no nurses amongst the vast hospital complex. Florence Nightingale was later to reckon the buildings could hold four miles of beds!

Of course, there was nothing particularly new about such conditions in a military hospital at a time of war. Nevertheless, Britain’s French allies were providing much better treatment for their wounded. Catholic nuns nursed the French wounded with a degree of care and discipline unknown to the British.

Had it not been for “The Times” newspaper it is probable that nothing would have happened to alleviate conditions at Scutari. However, the Crimean War was the first war to be properly reported in the press. War correspondent, William Russell, served with the army and sent regular dispatches back to London. “Are there no devoted women among us,” he thundered ,”able and willing to go forth and to minister to the sick and suffering soldiers of the East?…Are none of the daughters of England, at this extreme hour of need, ready for such a work of mercy? Must we fall so far below the French in self-sacrifice and devotedness?”

The picture painted by Russell of wounded soldiers dying from infection and disease through lack of care, caused an outrage in Britain. The Government was castigated for its failure to act, and in particular, for its failure to provide nursing care. It was against this background of national disgrace and public agonising that Florence Nightingale emerged.

In many ways Miss Nightingale was the last person who could be expected to emerge. It was, after all, an age when hospital nursing in Britain was confined, at best, to the religious orders and at worst to drunks and thieves. Those who could afford it would be nursed at home. Born in 1820 and named after her place of birth, Florence came from a wealthy English family with estates in Hampshire and Derbyshire. She was expected her to act out her social role as a lady. This would include marriage to a wealthy gentleman and exertions which did not extend beyond managing servants within a large household. But Florence had always been a rebel. Highly intelligent, she had persuaded her father to personally tutor her to an educational standard normally available only to boys. This included Greek, Latin, French, German and Italian, as well as a firm grounding in history and philosophy.

At first, it had seemed that, for all her education, Florence’s career would follow a conventional pattern. Indeed, in 1839, she was one of a string of young ladies presented to Queen Victoria as part of the social season in London. She was soon bored by this idleness. Her parents consented to her visiting the poor and sick on the family estates. Florence soon realised that she had found her vocation. Her parents were less certain and refused her permission, when she was aged 24, to train as a nurse at Salisbury Infirmiary. Matters changed when she became acquainted with Sidney Herbert, Secretary to the Admiralty. He took her concerns about nursing and health, seriously and introduced her to a wide circle of similar minded people. Florence began to read earnestly about the issues, diligently absorbing official publications. Such was her determination to devote her life to this cause that she reluctantly turned down a marriage proposal from Richard Monckton Milnes, a journalist for whom she had genuine affection.

In 1851 Florence’s parents finally accepted their daughter’s vocation. They allowed her to work at the Kaiserwerth Institution near Dusseldorf in Germany. This religious foundation of the Protestant faith, combined hospital, orphanage, school and mental asylum. In 1853, some time after returning to England from Kaiserwerth, Florence felt able to accept the post of superintendant at a recently founded hospital for “Sick Gentlewomen in Distressed Circumstances” in Harley Street. During the summer of the following year she supervised nurses at the Middlesex Hospital during a cholera epidemic. This dangerous work was to give her some experience of the horrors awaiting for her in the Crimea.

“The Times” reports of the condition of soldiers wounded in the Crimean War were especially alarming to Florence Nightingale’s old friend, Sidney Herbert, who was now Secretary of State for War. In October 1854 he wrote to Florence to ask her to organise and lead the nurses who were now offering to travel to the Scutari hospital to help.

His letter crossed one from Florence Nightingale which was already in the post. She was offering her services. Within a month she was at Scutari, at the head of a nursing mission which arrived on November 4th. – the eve of the battle of Inkerman. Conditions at Scutari were even worse than reported in “The Times”. One of the nurses, Sarah Terrot, wrote this:

“The scene baffles description. Horror upon horror crowds upon my mind…the misery of the dying was also aggravated by the vermin…night is especially trying…At this period there were no night nurses, but Miss Nightingale, lamp in hand, each night traversed alone the four miles of beds.”

It was probably not surprising that, at first, the army medical staff regarded Miss Nightingale and her mission with scorn and suspicion. Her presence was, after all, a indication that there own efforts were inadequate. Nor did they think it appropriate that women nurses should be in such close proximity to soldiers. Initially, the new nurses were allowed only to prepare dressings and cook food. However, as casualties increased, necessity compelled the army to fully involve the nurses.

The casualties of the previous month’s Battle of Balaclava were still arriving and without Florence and her nurses the hospital at Scutari would never have coped. It was during this battle that there occurred the famous charge of the light brigade recalled in Tennyson’s poem, which includes these immortal lines:

“Half a league, half a league,
Half a league onwards,
All in the valley of Death,
Rode the six hundred.
“Forward the Light Brigade!
“Charge for the guns!”
he said. Into the valley of Death Rode the six hundred…

Cannon to the right of them,
Cannon to the left of them,
Cannon in front of them
Volleyed and thundered; …

When can there glory fade?
O the wild charge they made!
All the world wondered.
Honor the charge they made!
Honor the Light Brigade,
Noble six hundred!

Men who displayed such courage as Tennyson describes, and who suffered injury or illness, deserved proper medical treatment and care. Florence Nightingale was passionate in her resolve to ensure that they, and all wounded soldiers, received it. She realised that unhealthy hospital conditions was killing more soldiers than the war itself. She, consequently, insisted on a tough new regard for cleanliness. Floors were scrubbed and linen kept clean. Beds were properly spaced and fresh air circulated through open windows. The nurses themselves wore tidy and clean uniforms. Proper food was prepared in a new kitchen. Above all, effective sanitation was introduced, with working drains, lavatories and clean water made a priority. Another 46 nurses arrived in December 1854 and “The Times” had a relief fund up and running. As standards of care improved more and more men began to survive. After six months the death rate had fallen from 420 per thousand to 22 per thousand!

Florence Nightingale was a model of self-sacrifice. Some reports have her working for up to 20 hours a day. She expected and received similar effort from her nurses. The jealousy and hostility of army doctors was as nothing compared with the adoration she received from the wounded. One old soldier later wrote, “What a comfort it was to see her pass. She would speak to one, and nod and smile to as many more; but she could not do it all you know. We lay there by hundreds; but we could kiss her shadow as it fell and lay our heads on the pillow again content.”

Towards the end of the war Florence visited the Crimea itself. She was hailed by the soldiers as a true heroine and “the soldier’s friend”. Similar acclamation greeted her when she returned to England in 1856, after the war had finished. Queen Victoria, herself, bestowed on Florence the thanks of a grateful nation. Although her personal health had suffered as result of the Scutari experience she battled on, semi-invalid. A large Nightingale fund had been collected and she used it to set up the first school for nurses in Britain. It opened in 1860 at St. Thomas’s Hospital in London. To help its training programme she published “Notes on Nursing: What it is and What it is not.”

The Nightingale Nurses trained at St. Thomas’s had to survive a strict regime aimed at establishing a respectable image for the new profession. It certainly worked. Furthermore, many of these nurses helped set up new training schools elsewhere across the country. When World War War I broke out in 1914 there were 80,000 trained nurses in Britain.

Florence Nightingale also had a major impact on medical care in the army. Her campaign for permanent change helped persuade the Government in 1857 to set up a Royal Commission. Important reforms followed, including the opening of an army medical college at Chatham in 1859. Two years later Britain’s first military hospital was set up Woolwich. An army sanitory commission was put into place to oversee the enforcement of the new standards.

Towards the end of her long and active life Florence Nightingale became increasingly disabled. She did not feel able to leave her London home after 1896. By 1901 she was almost totally blind. This brought her passion for letter writing and correspondence to an end. But she was never forgotten. In 1907 King Edward VII made her the first woman to receive the Order of Merit, and the following year she was given the Freedom of the City of London. Having lost the ability to speak for the last six months of her life, Florence Nightingale died in 1910, aged 90. She was buried in the family vault – contrary to her wish that her body be used for dissection in a teaching hospital.

The influence Florence Nightingale has had on medical care has been profound. At the end of the American Civil War (1861-1865) the Secretary of the U.S. Christian Union wrote to these words in a letter to her:”Your influence and our indebtedness to you can never be known”

The light which flickered from the lamp of Florence Nightingale on the wards at Scutari has never been extinquished. Her monument is still here today – amongst the nurses who care for us.

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