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12 May is International Nurses Day.
It is also the birthday of the most famous and influential nurse, Florence Nightingale.
Few people realise the enormous debt which the whole world owes to Florence Nightingale. This courageous Reformer transformed hospitals and pioneered the modern nursing profession. No other person in history has done more to alleviate suffering and establish so high a standing of health care for the sick.
The Degraded State
Before Florence Nightingale the condition of hospitals and the nursing profession was in a degraded state. Hospitals were dirty and over-crowded. Antiseptics were unknown. Scarcely any facilities for the training of nurses existed, and their pay was less than that for a common labourer in the field. Nurses were drawn from the “undesirable sections” of society and were commonly regarded as “vulgar”, “uneducated”, “unclean” and were notorious for their drunkenness and immorality.
Florence Nightingale was named after the town in Italy where she was born on 12 May 1820. Until that time, Florence was always understood to be a man’s name, but through her parent’s tendency to name their children after their town of birth, Florence has become an honoured woman’s name.
Florence’s parents were wealthy and well-connected. Florence was highly educated. A governess taught her music and art, and her father, William, taught her Greek, Latin, German, French, Italian, grammar, history, mathematics and philosophy. Florence loved books and immersed herself in her studies. She felt alienated from those around her and was profoundly dissatisfied with “the emptiness” of her existence. She was distressed at the pettiness of social life. She developed a passion for neatness and accuracy. Visitors described her as: “Stubborn”, “Strong willed”, “very intelligent,” and “Extraordinary!”
On 7 February 1837, just before she turned 17 years old, Florence wrote: “God spoke to me and called me to His service.” Florence travelled widely throughout Europe and even to Egypt. She was well aware of the misery of the poor. She became convinced that God had called her to reform the nursing profession and devote her life to the alleviation of suffering for the sick. Her parents were horrified and expressly forbade her to pursue such a degrading occupation. So Florence carried on her investigations, studies and correspondence concerning Hygiene, Sanitation and Nursing in secret.
Intelligence and Intergrity
In her 20’s, Florence was described as: “Tall, slender, elegant and very straight, her hair of a rich brown, her complexion delicate, her grey eyes pensive, yet ready to light into mirth with a smile the sweetest and most winning.” Her personal charm, intelligence, wide reading and sincerity attracted many friendships and marriage prospects - which she spurned.
Seeking First God’s Kingdom
At the age of 30, Florence wrote: “I am 30, the age at which Christ began His mission. Now, no more childish things, no more vain things, no more love, no more marriage. Now Lord, let me think only of Thy Will.”
Training in Germany
Florence travelled to Germany to enroll at a college for Deaconesses. She was a star student at the Lutheran Deaconess Training Institute at Kaiserswerth on the Rhine in Germany. She lived a spartan life in this college, rising at dawn, doing all the menial services, sharing the frugal meals of the sisterhood and attending lectures on nursing. On her return to England she set up a Sanatorium for Sick Governesses run by a Committee of Fine Ladies. This establishment for gentlewomen in Harley Street, London was used to test her innovative ideas on health care. At first there was conflict with the Committee, but in time all the members came to respect her innovations and skill in management.
Hygiene and Fresh Air
In the treatment of the sick, her first principles were cleanliness and fresh air. Contrary to all the tenets that then held sway, Florence began by insisting upon large and open windows for all hospital wards. “Thoroughness, initiative and hygiene” characterised the routines established by her. She produced the most detailed study into the state of health care in Europe
The Crimean War
Florence was just about to assume the superintendence of Kings’ College Hospital when the Crimean War broke out. After the Battle of Alma, in September 1854, The Times correspondent wrote on the shameful lack of proper provision for the care of the wounded after their heroic victory.
Disaster and Disgrace
“There were not sufficient surgeons; no dressings and no nurses; no linen for bandages – and yet, no one was to blame!” This was the first war in which the telegraph was used to wire dispatches back home, so for the first time up-to-date reports kept the people in England informed on the course of the war and the horrors of having no proper medical care for the wounded.
To Care for the War Wounded
As an outcry of indignation arose throughout the country, the Secretary for War, Sir Sydney Herbert, wrote to Florence asking if she would go to organise the care of the wounded in the Crimea. Within two days of receiving the letter of appointment from the War Office, Florence Nightingale set out (21 October 1854) for Turkey. She was accompanied by 38 hand-picked volunteers, whose abilities she had proved. Her sister wrote that Florence “was as calm and composed in this furious haste…as if she were going out for a walk.”
With the announcement of her government appointment, Florence Nightingale came under national attention and became the target of much controversy. It was only after Queen Victoria gave Florence her personal support that most of the accusations against her subsided. Many high officials objected to a woman taking charge of what was essentially “a man’s job.” Others were astounded that a rich, popular, young and attractive gentlewoman was prepared to abandon her life of ease and luxury in England to face dangers, horror and fearsome toil on the battlefield.
Apparently Florence took no notice of her critics. She reached Scutari on 4 November, just in time to receive a flood of wounded from the Battle of Balaclava. While struggling to cope with the Herculean task of tending these casualties, a further 600 wounded arrived from the Battle of Inkerman. She endured the prejudice and opposition of military surgeons, endured unimaginable squalor, a devastating cholera epidemic and battled against bureaucratic bungling from the start.
She reported that: “Far more soldiers had died of disease than on the battlefield.” She described the hospitals as “colossal calamities.” There was no furniture, and no cooking utensils. Toilets were blocked and overflowing. Rats were everywhere. The filth and stench of rotting wounds were overwhelming in the overcrowded, rat, cockroach and lice invested corridors and wards.
When informed that essential items that she needed would take weeks of delay, authorisation from England, and that she needed to await official reaction to the Commission of Enquiry, Florence Nightingale used her own funds to set up a house in Scutari as a laundry, and requisitioned a consignment of 27,000 shirts, which had not yet been released by the Board of Survey. Florence ordered that the bales be opened at once, and the materials delivered to the hospital: “Red tape or no red tape.” Many officials were incensed: “Is this the way to manage the finances of a great nation! Miss Nightingale coolly draws a cheque!” In fact, Florence paid for many of the supplies out of her own funds.
Apparently unconcerned by the controversies and furore surrounding her, Florence continued her work of cleaning up the shambles she had found. Those of her helpers who would not submit to the strict discipline, or endure the necessary privations, were promptly sent home. Official obstructionism impeded her efforts at every step, but she overcame all opposition with her persistence and determination. As Florence wrote: “I have no compassion for men who would rather see hundreds of lives lost than waive one scruple of the official rules.”
She organised staff, oversaw purchases, set up housekeeping, ordered furniture, supplied clothing, supervised daily routines, working an average of 20 hours every day, performing the duties of cook, housekeeper, washerwoman, general dealer and storekeeper along with scavenger and nurse. Florence began and ended each hospital day routine with prayers. She also provided reading rooms and library books for the patients.
It was her custom before retiring to make a last tour of the wards. Her tall slender figure in nurse’s uniform, rich brown hair covered by a white cap, passing, lamp in hand, down the long isles between the rows of beds, bestowing comfort on the wounded seemed like an angel to the hundreds of wounded and sick soldiers.
Florence visited the battlefront to set in place further reforms. Hospital mortality (the death rate of patients) before she took over the care of war-wounded in the Crimea was as high as 42%. Soon Florence brought hospital mortality down to only 2%,
As Dr. Benjamin Jarved of Oxford declared: “Nobody knows how many lives are saved by your nurses in hospitals, how many thousands of soldiers who would have fallen victim to bad air, bad drainage, and ventilation are alive owing to your forethought and diligence.”
Towards the end of the war, Florence succumbed to a severe fever, which could have easily taken her life. She recovered, but her health was so damaged that she would never be the same again.
In spite of her sickness and weakened condition, Florence refused to leave her post of duty until the British army evacuated Turkey at the end of the war in July 1856.
Travelling under a false name, as “Miss Smith”, she avoided the enthusiastic receptions that had been arranged for her, but was received by Queen Victoria, whom she persuaded to support hospital reform. Prince Albert described Florence as “extremely modest.”
Florence’s work in the Crimea was, to her, only a beginning. She founded the Nightingale Home for Training Nurses at St. Thomas’s Hospital and published an 800 page report entitled: “Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army.” This formed the basis of a Royal Commission to reform medical care in the military. The Army Medical Corp was transformed as a result of her efforts.
Florence took a deep interest in the sanitary and health measures adopted in India and was in constant communication with the Secretary of State for India to reform sanitation and health in that vast country.
Health Care Reform
Florence launched the most significant campaigns to improve health care and prevent patients dying from causes which could have been prevented. She strove to learn from the past in order to save lives in the future. It was her goal to ensure that those who had suffered in Crimea had not suffered in vain. She changed forever the status of the nurse and the fate of the soldier.
Her “Notes on Hospitals” revealed that civilian hospitals were as bad, if not worse, than military hospitals. She worked late into the night establishing effective training for nurses, setting new standards for sanitation and drainage. Her research reports dramatically improved working conditions for the poor and health care for the sick. Her requirements for nursing included that they must be: “Sober, honest, truthful, trustworthy, punctual, quiet and orderly, clean and neat.”
In Spite of Ill Health
Struggling against ill health herself, and surrounded by a colony of cats, Florence Nightingale continued her crusade to save lives and provide efficient, effective health care for the infirm.
Notes on Nursing
The Florence Nightingale Museum records that she wrote 200 publications and 13,000 letters. Her most famous book: “Notes on Nursing” has been translated into many languages including German, Dutch, Danish, Swedish and Finnish. It remains a classic resource and textbook for nurses, managers and health planners to this day. It dealt with all aspects of health care, including hygiene, bedding and diet. It emphasised the two most important principles of nursing: observation (such as the pulse, appetite and breathing of a patient) and sensitivity to a patient’s needs and comforts.
Florence incorporated Bible studies and prayer meetings as part of her trainee nurse’s routines and appointed chaplains for the hospitals.
Florence Nightingale’s writings on hospital planning and organisation had a profound impact on health care worldwide. Her far-sighted reforms saved innumerable lives and established nursing as a respectable profession.
A Most Productive Life
After a most productive life, at age 90, Florence Nightingale died on 13 August 1910. Over 1,000 nurses and many veterans of the Crimean War attended her funeral service at St. Paul’s in London. Lord Stanley delivered this eulogy: “I know of no person besides Miss Nightingale who, within the past 100 years…has voluntarily encountered dangers so imminent, and undertaken offices so repulsive, working for a large and worthy object, in a pure spirit of duty towards God and compassion for man.”
“Then the King will say to those on His right hand, ‘Come, you blessed of My Father, inherit the Kingdom prepared for you from the foundation of the world: for I was hungry and you gave Me food; I was thirsty and you gave Me drink; I was a stranger and you took Me in; I was naked and you clothed Me; I was sick and you visited Me; I was in prison and you came to Me.... Assuredly, I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me.’” Matthew 25: 34-40
Dr. Peter Hammond
PO Box 74 | Newlands | 7725 | Cape Town | South Africa
Tel: +27 21 689 4480
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