Florence Nightingale

Florence Nightingale
Arrival at Scutari: November 4, 1854

Florence Nightingale
Birth: 1820
Death: 1910
Rank: Nurse

Problems in caring for the Wounded (1854 - 1863)
The greatest killer of soldiers, up until the twentieth century, was not the bullets and bombs of his foes, but disease. Cholera, malaria, and typhus worked their evil way across bivouac and hospital, spreading dysentery and death wherever they went. Infection and lack of sanitary practices among medical staff helped increase the spread of bacteria to men already weakened from wounds and sickness. Too few trained medical personnel meant overburdened surgeons could not possibly attend to the thousands of casualties produced by battle, leaving many men unattended as their wounds festered. Blood loss, inattention, and septic shock killed thousands.

Of the twenty-two thousand recorded deaths of the British Army in the Crimean War (1853 - 1856) over seventeen and a half thousand - a staggering 79% - were lost due to disease and poor sanitary conditions. Likewise, the French and Russian armies suffered equally to pestilence, and basic medical care was often overwhelmed in the wake of battle. Institutional inadequacies plagued the army’s ability to care for its wounded. Want of supplies, and attention from surgeons, led the special correspondent of the London Times, Howard Russell, to write indignantly:

Not only are the men kept, in some cases, for a week without the hand of a medical man coming near their wounds...but now, when they are placed in the spacious building, where we were led to believe that everything was ready which could ease their pain or facilitate their recovery, it is found that the commonest appliances of a workhouse sick-ward are wanting.

These scathing reports were not merely a British problem, indeed, medical shortages, and the consequent suffering of men on the field of Solferino in 1859, prompted a Swiss banker holidaying in Italy, named Henri Dunant, to write a descriptive memoir of the horrors he’d witnessed in that terrible battle’s aftermath:

The numbers of convoys of wounded increased to such proportions that the local authorities...were absolutely incapable of dealing with all the suffering...there were not enough hands to dress wounds...there was a shortage of medical orderlies, and at this critical time no help was to be had.

Moving among the overcrowded hospitals, Dunant could not help but be moved by scenes coming straight from Dante. Within five years of Solferino, Dunant had fashioned a society bent solely upon the care of the wounded of all nations in times of war; it still bears the name of the International Red Cross. Russell and Dunant’s experiences weren't unique, for across the Atlantic, the poet Walt Whitman wrote of shared deficiencies and suffering of the wounded in the American Civil War.

Volunteering as a nurse, Whitman worked in the grim field hospitals. As in Europe, shorthanded and overworked staff, and a lack of understanding concerning the nature of germs, fueled the spread of infections among the vulnerable patients, killing thousands. “It is a dreadful thing,” Whitman wrote to a friend, “the sad condition in which many of the men are brought here...Down in the field hospitals in front they have no proper care & attention, & after a battle go for many days unattended to.” But even in the face of such carnage, disease trumped battlefield casualties, as maladies worked overcrowded bivouacs and hospital wards. Among the many that sought to combat such problems was a thirty-four-year-old nurse named Florence Nightingale, who arrived at the British Army hospital at Scutari in early November, 1854.

“A Lady with the Lamp”
In 1860, Florence Nightingale observed in her Notes on Nursing that symptoms from which a patient suffers are not necessarily derived from the disease, but rather hail from the “want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of the punctuality of care and administration of diet, of each or all of these things.” Articulating her theme still further, Nightingale noted that if a patient suffered from cold or bed sores it was hardly the fault of the disease, but rather that of the nurse. “Bad sanitary, bad architectural and bad administrative arrangements often make it impossible to nurse.” Experience guided her observations, hard-earned in the deplorable conditions of the disease-ridden hospitals of Scutari.

The Crimean War was fought on the Crimean Peninsula, with rear area hospitals centered in the Turkish town of Scutari, near Constantinople. Moved, as were many, by Russell’s dispatches from the front, Nightingale decided upon venturing out to Turkey to administer to the sick and wounded. She was a prime candidate for this job, for Nightingale had experience as superintendent of a Hospital in Harley Street, in London. The need for nurses was great, but to be led by one who knew her business was crucial. In a letter to Nightingale, with whom he had a personal friendship, the Secretary at War, Sidney Herbert, asked her to take on the job. Consenting, on October 20, 1854, Nightingale got her official orders directing her to head to Scutari where, on “arrival there place yourself at once in communication with the Chief Army Medical Officer...under whose orders and direction you will carry on the duties of your appointment.” The duties of the nurses; how best to employ them; the lengths of their shifts, and the amount of their wages were left to Nightingale’s discretion, though subject to the approval of the presiding medical officer. Personally hand picking her team, she was off within weeks.

The greatest deficiencies she found upon arrival were the hygiene regime given to the patients. “When we came here,” she reported to Herbert:

there was neither basin, towel, nor soap in the wards, nor any means of personal cleanliness for the Wounded except... [that] thirty were bathed every night… but this does not do more than include a washing once in eighty days for 2300 men.”

Lack of proper sanitary practices led countless men to die from infections and disease, brought upon by the infrequent replacement of soiled bandages and linens. These problems derived from the lack of coordination between the various departments. Medical supplies were often packed on ships below ammunition crates and shells for the artillery. Attempting to unpack these necessities often proved far too difficult and were sometimes abandoned altogether, as removing them would first mean the removal of the supplies above them.

A further problem concerned the possibility of further nurses arriving without Nightingale’s consent, for the Secretary at War had promised her that selection of the nurses was her prerogative and hers alone. Consulting with “Mr. Menzies,” the Army’s principal medical officer, Nightingale refused the offer of further nurses because conditioning the nurses already working to the strictures of military discipline had been difficult enough. “If we were swamped with a number increased to sixty or seventy, good order would become impossible. And in all these views,” she wrote to Herbert, “I so fully concur that I should resign my situation as impossible, were such circumstances forced upon me.” Nightingale was having discipline problems among her original party; adjusting these Victorian women to cramped quarters, and the difficult nature of their task, wasn’t easy, after all.

Her close connections with the Secretary at War gave Nightingale a direct link to the highest realms of government, to call to their attention the major inadequacies of the British army’s medical arrangements. Her efforts brought about a reduction in lives lost among the British patients at Scutari, and her work helped affect postwar training of surgeons and nurses, administrative flaws, hospital design, and patient treatment. But she was not the only one, indeed, not even the first to embark for the Crimea. Mary Seacole, born in Jamaica to a British Army officer and Jaimacan woman, journeyed to Scutari, hoping to work with Nightingale. But her advances were rebuked, so she decided to go directly to the Crimea and set up a hotel behind the lines, providing the soldiers with meals and comfort, as well as medical care.

Working with the French forces were no less than fifty Catholic Sisters of Mercy, and countless hundreds more of the venerable cantinière, who acted as sutlers and makeshift nurses. The cantinière were seasoned campaigners who followed their regiments into battle. The sister-in-law to the Czar of Russia, Elena Pavlovna, organized her own nurses to care for the Russian wounded, as well. The Society of the Holy Cross sent women to the front where several were killed, and in this very grim respect, differed from Nightingale’s efforts in Scutari, for Nightingale never went near the front, nor did any of her nurses.

Her time in Crimea shaped Nightingale’s later attitudes towards patient care, and training of those who’d care for them. Battlefield medicine, and medicine in general, would advance in the decades to come, as would the structure of hospitals. To prepare future generations of caregivers, Nightingale established a school of nursing, instilling within them lessons garnered through long and bitter experience in the wards of Scutari.

Did you know? While Florence Nightingale is justifiably famous for her efforts in the Crimea, she wasn’t the only one. Indeed, the need for sanitary hospitals to care for the sick and wounded was so great, that British engineer Isambard Kingdom Brunel designed an entire hospital made up of prefabricated wooden huts. Brunel’s designs took into account the need for ventilation and drainage, as well as the hygiene needs of the patients. To administer this hospital, based at Renkioi - on the Gallipoli peninsula, was Dr. Edmund Alexander Parkes. It had one of the lowest death rates of any hospital administered during the war.

Florence Nightingale (High School Activity) - For thousands of years, disease was the great killer of soldiers. Armies were ravaged by it: cholera, typhus, dysentery - these killed far more men than the bullets and bayonets of the enemy. When Britain went to war against Russia in the Crimea, the conditions of the army hospitals were appalling. There were not enough doctors, there were inadequate sanitation practices, and - as a result - hundreds of men died for want of proper care. But these things take time to change, and up until World War One, and even beyond, disease still carried off more than battle. Understand that, in the nineteenth-century, germs were not fully understood, nor were antibiotics readily available. Penicillin didn’t yet exist, and in crowded army hospitals, there was only so much that the overworked surgeons and orderlies could do. For this activity, write a brief summary of medical techniques as it pertained to war in the nineteenth century. How did doctors and nurses cope with the disease-ridden ranks, and battle maimed men, that came before them? For background on this era in military medicine, see here:

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