I vaguely remember learning something about Florence Nightingale at school. The only thing that stuck was that she was called “The Lady with the Lamp” because she would walk hospital corridors at night, checking on the patients. It’s only recently that I realised how much more there is to her story and started to read about her – because what she achieved is fascinating.
I read this relatively new (2017) biography called “A Brief History of Florence Nightingale and Her Real Legacy, a Revolution in Public Health” by Hugh Small.
Apparently Florence was a wealthy and highly-educated young woman determined to contribute to society by becoming a nurse, a goal from which her family tried to dissuade her. She persevered and became a hospital administrator, and in her thirties headed a group of nurses to work in the Scutari hospital serving soldiers from the Crimean war (1853-1856).
Her skills were not so much in the physical acts of nursing (though apparently she was fascinated to watch the surgeons at work), but as a manager and coordinator. It sounds as though she had her work cut out – firstly in carving a position for her nurses within a hospital hierarchy dominated by male doctors, then in trying to secure supplies and decent care in horribly overcrowded conditions.
She was also fascinated by statistics, having fought to be taught mathematics when she was younger. It was her interest in statistics that was to do the greatest good to society – while also causing herself much personal grief. On return to England they showed her that Scutari had, in essence, been a death camp, with huge numbers of deaths not from injuries but from preventable diseases such as typhoid.
This was before the “germ theory of disease”, when nobody knew that such diseases are spread by bacteria. There was some awareness of the importance of good sanitation by way of clean water supplies and waste disposal, to avoid contamination of drinking water by sewage, however little recognition of the potential for disease to spread through lack of hand-washing, say, or through droplets in the air. It seems that putrid smells were considered nasty, but essentially harmless.
When Nightingale realised the truth of the death rate at Scutari, at first she blamed the army for inept coordination of supplies such that the soldiers were in poor condition, half-starved and frostbitten, on arrival. In her intense, driven way, she did her best to bring this to the government and create change, with some success.
But then, the statistics revealed her to be wrong. The death rate at Scutari was higher than in other hospitals, ones she had considered less well managed. Something had gone terribly wrong within her hospital under her watch. What a huge burden of guilt she must have felt, on realising this! Was this the trigger for her breakdown, that saw her confine herself, out of sight?
I suspect a lesser person would have continued in deliberate ignorance of the truth, to avoid shame. But as Miss Nightingale started to recover her health, she courageously took the data and her thoughts on nursing and published them. She produced her famous “coxcomb” or “rose diagram” (below), setting out the statistics on soldier mortality for all to see. The book states this as the first use of statistical graphics to support an argument for change – by demonstrating that epidemic disease could and should be controlled by non-medical means.
She also published “Notes on Nursing”, with its emphasis on the basics of good ventilation, cleanliness, patient nutrition, and timely disposal of wastes. Importantly, she lobbied for better consideration of public health and sanitation in the design of hospitals and the urban landscape in general.
I hope you are as fascinated as I am by what this amazing woman achieved. But perhaps you are wondering why I titled this post “A Reminder to be Thankful”?
This was because I was shocked at a statistic in the book, that life expectancy in the mid-nineteenth century England was around 40 to 50 years. So very low!? At first I doubted.
Coincidentally I received from my mother this week a fascinating booklet tracing back her family tree. The nineteenth-century forebears were shown on the first pages, posing seriously in their finest clothes. There was John, who died in 1838 at 35 years of age, leaving behind 7 children. There were Abram and Nancy, who lived to the ages of 53 and 44 respectively, and left 5 children. There was Matthew, the wealthy inheritor of the local manor house, who passed away at the age of 52, leaving 5 children. Oh my! And these were not the urban poor of London made famous by Dickens, but (it seems) spinners and weavers in the mills of West Yorkshire.
So this is why I am reminded to be thankful. I come away from my reading awed by the sacrifices and the sheer grit of my ancestors, of all our ancestors, in the face of genuine, life-shortening adversity. And for all that I tend to worry about the state of the world, and the ongoing incompetence and corruption of our so-called leaders, I am exceedingly glad to be alive now, and not then.