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by Deborah Pulliam

Florence Nightingale was distinctly not the romantic, retiring Victorian gentlewoman most of us imagine. She was a bright, tough, driven professional, a brilliant organizer and statistician, and one of the most influential women in 19th-century England.

The best-known aspect of her life–nursing wounded soldiers at Scutari Hospital in Turkey during the Crimean War–comprised, in fact, a very small part of her 50-year career, but provided the springboard from which it all began.

Looking through a rough reproduction window at the London museum that bears her name is a little like peering over Nightingale’s shoulder in the Crimea and confronting the intimate details of life there–including her hand-drawn plan of the nurses’ quarters in the Barrack Hospital at Scutari, her personal seal and wax for letters, some of her books and her dispatch case, as well as an original letter written from the hospital and her famous lamp.

The museum’s permanent exhibit documents not only the war years, but also follows Nightingale throughout her extraordinary but largely overlooked life. A brief introductory film emphasizes her wealthy Victorian upbringing and expectations of a brilliant social career.

In fact, Florence Nightingale accomplished so much during her full life that it is intriguing to wonder how she might be remembered had the public not become so fixated on the romantic image of her night-time rounds by candlelight at Scutari. This small museum highlights all of her many accomplishments: introducing sanitary science to nursing and the British Army; raising the image of the British soldier from a brawling lowlife to a heroic working man; transforming nursing from an occupation which previously had been considered fit only for prostitutes to a respectable profession; establishing a nursing school at St. Thomas’s Hospital; laying out the principles of nursing in print in 1860; and revolutionizing the public health system of India without leaving England.

Ironically, during much of her long and accomplished life (she died in 1910, at the age of 90) the general public assumed she was already dead. Nightingale actually encouraged this misinformation. She returned from the Crimea under an assumed name and walked the last few miles to her parents’ home from the train station. Uninterested in her celebrity status, she wanted only to continue her work in peace and quiet. She refused photographs and interviews, and avoided anything not directly related to her work for a Royal Commission investigating health in the British Army. Although she was undoubtedly the driving force behind the work, she almost never appeared in public.

Her thoughts and work were with the army. In a private note, written at the end of 1856, she wrote:

Oh my poor men who endured so patiently. I feel I have been such a bad mother to you to come home and leave you lying in your Crimean grave. Seventy-three percent in eight regiments during six months from disease alone–who thinks of that now? But if I could carry any one point which would prevent any part of the recurrence of this our colossal calamity then I should have been true to the cause of those brave dead.

In the post-war period, Nightingale began studying new designs for modern hospitals all over Europe, in order to help the army reform its health and sanitary systems. In Paris she found a revolutionary design in which separate units, or pavilions, made up one large hospital. By making each pavilion a light and airy self-contained unit, the hospital minimized the spread of infections. She later succeeded in promoting this design in England.

Her research culminated in Notes on Hospitals, published in 1859, which combined two papers presented the year before at the Social Science Congress. Her words had a profound effect. She addressed every aspect of hospital management, from the purchase of iron bedsteads to replace the wooden ones, to switching to glass cups instead of tin.

The 108-page book went on into three editions and established Nightingale once more as an international authority. Her advice and approval were sought for hospitals all over Europe, from Holland to Portugal and even far-off India.

In particular, the governors of St. Thomas’s Hospital in London consulted with her on a matter key to the hospital’s future. The ancient hospital in Southwark was situated on land needed by railroads for a new line. The hospital’s governors had to decide whether they should sell the entire property and build a new facility in a better location, or allow the railroad to buy only part of the land and rebuild the hospital on the remainder. Some governors felt the hospital should stay where it had been for hundreds of years, serving the same community.

When they asked Nightingale for her opinion, rather than simply accepting the notion that the hospital was in fact serving patients in the area, she drew up and analyzed statistics on the origin of St. Thomas’s patients and proved that most did not come from the immediate neighbourhood as the governors had assumed.

She also compiled a convincing body of statistics to prove that moving the hospital to a healthier site would improve the patients’ chances of recovery. After completing her analysis, in a telling display of political acumen, she sent it not to the body of governors as a whole, but to one particular governor: the Prince Consort.

In the end, the governors decided to move St. Thomas’s to its present location in Lambeth. At the time, Nightingale deemed the site to be unhealthy; nevertheless, the hospital was constructed with the pavilions she endorsed, and was finally completed in 1871. If you look carefully from Westminster Bridge, you can see the remaining pavilions wedged in between more contemporary parts of the hospital that have since engulfed the original. Ask for directions in the museum, and you can walk through the new parts of the hospital to Nightingale’s original entrance hall.

Success piled on success. In 1860, after five years of gruelling work, she completed a voluminous report that resulted in the development of an Army Medical School in addition to greatly improved army barracks, hospitals, and living conditions for soldiers.

Also in 1860 she founded the Nightingale Training School for nurses at St. Thomas’s Hospital. Far more than merely giving her name to the school, Nightingale personally advised on all matters of instruction, admissions supervision, and discipline. Her involvement extended beyond her professional duties; she often invited graduates to tea and kept in touch with them long after they had launched their careers.

Nightingale also published a 75-page booklet, Notes on Nursing: What It Is, and What It Is Not. A popular book, its initial reception still did not foretell of its lasting importance. The book is still in print today in a facsimilie of the first edition and in a reprint of the second enlarged edition. In fact, it is the best-selling item in the museum’s small shop. “I think if you’re only going to buy one thing from our shop, it’s going to be Notes on Nursing,” says Alex Attewell, curator of the museum.

While medical knowledge has significantly increased since Nightingale’s time, her common sense and wisdom still forms a solid basis for caring for people. She believed, first and foremost, in hygiene (fresh air, cleanliness, clean water, proper drainage, and plenty of light), and constant consideration for the patient’s feelings. In one particularly empathetic passage, she addresses the importance of a quiet environment:

Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient. It is rarely the loudness of the noise, the effect upon the organ of the ear itself, which appears to affect the sick. How well a patient will generally bear, e.g., the putting up of a scaffolding close to the house, when he cannot bear the talking, still less the whispering, especially if it be a familiar voice, outside his door.

Nightingale’s common-sense approach to health is a main theme throughout the museum’s exhibits. “We’re interested in exploring what of her writing is still relevant today,” Attewell says.

Because of her work on army medical reform, she was asked to contribute to a study of the problems of health in India. British troops on the subcontinent had the highest mortality rates of all–in 1859 the death rate was 69 per thousand, as opposed to 17 per thousand in England. Through statistics and endless study, (compiled, amazingly, without ever visiting India) she discovered what no one else had noticed: that the English way of life could simply not be transferred to a hot climate.

Her 23-page treatise on conditions in India (as compared with the government’s 2,028 pages of small print) was printed at her own expense and sent to anyone with influence, including Queen Victoria. Once again, Nightingale revealed what no one even wanted to consider: that terrible living and working conditions were killing British troops as they had in the Crimea.

Yet again she emphasized that improving the health of British troops would require improving sanitary standards as a whole. For four years Nightingale worked daily on the meticulous paperwork and statistics required to reform life in India. Her influence went beyond paperwork. Newly assigned viceroys to India visited her home for briefings before setting out for their new post.

In 1896, Nightingale “retired to her bed”, but, far from slowing down, she continued working on home health visiting, as the English call public health. “Her writing is extraordinarily relevant to today’s health visiting,” Attewell says.

In an attempt to find out just how pertinent her writing is to the health profession today, the museum sent out questionnaires to 700 public health supervisors around the country. More than half came back almost immediately. “Usually you’d think a 10 per cent response would be good,” Attewell says. “I think the interest we’ve got in the questionnaire shows there’s still extraordinary interest in her writing.” Yet more evidence of the timeless value in the work and wisdom of this remarkable woman.