Honoring Nurses: Florence Nightengale
This week our country is honoring nurses. Today is National Nurses Day. This year is obviously even more special due to the coronavirus pandemic. As my mother was a nurse and one of my daughters is a physical therapist, it seems abundantly appropriate to write this blog about Florence Nightingale. It is also a connection to Matilda Joslyn Gage, as she volunteered in hospital wards near her home during the Civil War rolling bandages and nursing wounded and ill soldiers. Just as we are enduring the horrors of an extremely contagious disease, Nightengale battled Cholera during the Crimean War. In 1854, British troops invaded the Russian-held Crimean Peninsula in response to aggressive moves by Czar Nicholas I to expand his territory This scenario should sound quite familiar to us, as Putin put some of the same moves on the Ukraine Crimea with the struggle over the Crimea. Next week, on May 12th, Britain is also celebrating Florence Nightingale’s 200th birthday. They will lay a wreath at Waterloo Place, a special version of the annual Procession of the Lamp at Westminster Abbey, a two-day conference on nursing and global health sponsored by the Florence Nightingale Foundation, and tours of her summer home in Derbyshire.
About a dozen years ago when I visited Turkey for the first time, I crossed by ferry across the Bosporus Strait from the Eastern side of Istanbul (ancient Constantinople) to the Western side. My companion Aziz, whose father had been a famous Breast Cancer surgeon, pointed to a large building, the Barrack Hospital at Scutari. He informed me that this was the very building where Florence Nightingale toiled among thousands of wounded and sick British troops who had been transported across the Black Sea aboard filthy ships. She had 38 nurses under her command while she ministered to troops packed in squalid wards, many of them wracked by frostbite, gangrene, dysentery, and cholera.
Nightingale was a nurse for only three years. But her pioneering work as a statistician and as an early advocate for the modern idea that health care is a human right–just ask Bernie Sanders–and her insistence on being a tireless caregiver despite the objections of the British officers. (Misogyny, do ya think?) Nursing in those days was regarded as disreputable and suitable only for lower-class women. But Florence’s father, a wealthy heir living in a manor house, tutored had tutored her in mathematics and the classics. This is very similar to the instruction that Matilda got from her physician father. Also, just like Matilda, Florence grew up surrounded by intellectuals who were enlightened aristocrats who campaigned for outlawing the slave trade and other reforms. You may recall that Hezekiah, Matilda’s father, also maintained a house on the Underground Railroad. Thus, Florence “craved for some regular occupation, for something worth doing instead of frittering away time on useless trifles.” Despite the opposition of her parents and ridicule of her sister Parthenope, she was convinced her destiny was to do God’s work. To master her profession, she spent time at a highly regarded nursing school, Kaiserwerth in Germany. She served as superintendent there for the Care of Sick Gentlewomen, a hospital for governesses She also cared for prostitutes during a cholera epidemic in 1853. At Scutari, she would often go over the heads of her superior to order supplies from their stores. They also felt that she was too ambitious and always struggling for power.
Yet her first winter at Scutari, 4,077 soldiers died–ten times more from typhus, cholera, typhoid fever, and dysentery than from battle wounds. Eventually, a sanitary commission was dispatched to Scutari and deaths began to diminish. The commission cleaned out latrines and cesspits, flushed out sewers and removed a dead horse that was polluting the water supply. The mortality rate dropped from 42.7% to 2,2%. But Nightingale’s contribution was disputed in a controversial 1998 biography, Avenging Angel, which contends that Scutari had the highest death rates of any hospital in the Crimea. It accused her of not grasping the role of sanitation in disease prevention until many thousands had died. the author, Hugh Small, that she focused instead on giving troops warm clothing and hearty food. He also surmised that “repressed guilt” over her failures caused her to have a nervous breakdown, which turned her into an invalid for long stretches throughout the rest of her life. I can’t help but think of the dedicated doctor in New York who tirelessly treated COVID patients–most of whom died–killed herself this week, apparently not being able to take it anymore. But, actually, all Crimean War hospitals were ghastly and the statistics suggest that others had higher death rates than Scutari. Nightingale blamed the military doctors and administrators, chastising them for “a host of murderess error including sending cholera cases to overcrowded wards” and delaying having the hospital “drained and ventilated. “The sanitation commission investigation confirmed Nightingale’s suspicions about the links between filth and disease. The Crimean War killed 900,000 combatants. The horrors Florence Nightingale witnessed at Scutari weighed on her the rest of her life. She later described the words she first encountered as “slaughterhouses.”
In Balaklava, a fishing port in the Crimea, Nightingale would climb from the harbor to the Castle Hospital, which was just a collection of huts and barracks on a flat patch of ground overlooking the Black Sea. She had sailed there from Scutari across the Black Sea to inspect medical facilities near the front lines. The 34-year-old Nightingale drilled borehole wells to improve the water supply and insulated huts with felt to protect wounded soldiers against the winter cold. She worked to improve their food by regularly making sure the soldiers received meat, not just gristle and bone. She had fresh bread shipped in daily from Constantinople. She also braved bullets traveling by carriage, on horseback and on foot to inspect other hospitals. She even visited the trenches outside Sevastopol, where she was moved by the sight of the troops “mustering & forming at sundown.” Maybe worse was the resentment of officers and bureaucrats who regarded her as an interloper. She wrote in her journal,” There is not an official who would not burn me like Joan of Arc if he could, but they know that the War Office cannot turn me out because the country is with me.” She became ill with what the troops called “Crimean Fever,” an inflammation of the vertebrae that would leave her in pain and bedridden for much of her life. Despite her illness, she was determined to work until the last British troops had gone home, returning twice during the war. In a letter she wrote, “I have never been off my horse until 9 or 10 o’clock at night, except when it was too dark to walk home over these crags even with a lantern. During the greater part of the day I have been without food, except a little brandy and water (you see, I am taking to drinking like my comrades in the army)”
The Treaty of Paris ended the Crimean War. She had spent almost two years in the conflict zone. A front-page engraving in the Illustrated London News showed her making her rounds with her lamp, looking very heroic. Once back in England, she gathered data from military hospitals in Constantinople that verified what she had long suspected: Nearly seven times as many British soldiers had died of disease in the Crimean War than in combat, and the deaths dropped dramatically once hospitals at the front were cleaned up. She also collated data from military hospitals in Great Britain, which were so poorly ventilated, filthy, and overcrowded that their mortality rates far exceeded those at Scutari following the changes implemented by the Sanitary Commission. She shared her graphics with the military convincing them to improve hospitals throughout Great Britain. Parliament voted to finance the first comprehensive sewage system for London. In our present day, Italy has started to check the sewers to examine for the coronavirus’ presence, yet another source of this deadly modern-day plague.
Though often bedridden, she continued to gather data on every aspect of medical care. She sent questionnaires, collected and analyzed results, wrote reports, and established investigative commissions. Nightingale came to believe that Using statistics to understand how the world worked was to understand the mind of God. She founded the country’s first nurses’ training school. for her, it was a moral crusade intended “to promote the honest employment, the decent maintenance, and provision, to protect and restrain, to elevate in purifying…a number…of poor and virtuous women.” Like Matilda, she criticized the Poor Laws, prodding Parliament to improve the workhouses (shelters for the indigent and used trained nurses. A radical–like Matilda–she had “a non-judgmental, non-moralistic view of the poor.” She also wrote prolifically about crime, labor and the social causes of madness. She also originated the concept that soldiers injured in war should be considered “neutral” and that they and their caregivers should be accorded protection on the battlefield. That ethic became central to the International Committee of the Red Cross, which was founded in Geneva in 1863.
Think about what our nurses around the world have been through since the beginning of our current epidemic. Think about the couple of dozen nurses from Syracuse who volunteered to go to the heart of NYC for two weeks to attend to severe cases. Think about all the death and trauma they experienced throughout exhausting days and nights. It makes me want to stand up and applaud like the citizens of New York City do from inside their apartments every night at 7:00 pm. Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap, Clap…