The Can-Do Wisdom of Florence Nightingale – Part 2 examines the brief period of Florence Nightingale’s public life covering her first nursing experience and then as Superintendent of female nurses at the Scutari Military Hospital in Constantinople during the Crimean War. This is where her knowledge and organizational skills, her observations, her leadership, her network of contacts, and her communications abilities were used to ‘get things done’ when others said it ‘couldn’t be done’.
I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.
– Florence Nightingale [2]
First Work in Nursing: Harley Street (1853-54)
The Establishment for Gentlewomen during Illness had been operating as a London nursing home for ‘educated’ women of moderate means since 1848. There were only six beds in the original home in Chandos Street, off Cavendish Square. The establishment needed reorganizing, including a move to new, expanded premises. The new location would house 20 beds in a three-story home on Harley Street, London, which in later years would become famous for its large number of private specialists in medicine and surgery.
Florence insisted on hot water being piped to each of the floors and a dumbwaiter lift be installed to bring meals up from the basement kitchen. Another innovation she requested was that “. . . the bells of the patients should all ring in the passage outside the nurse’s door on that story and should have a valve which flies open when its bell rings, and remains open in order that the nurse may see who has rung.”[3]
The new hospital eventually opened on 7 August 1853.
Against the wishes of the committee, she demanded that the hospital be open to all faith denominations, not just Church of England. These were just a few of the surprises she had in store for the overseeing committee. There were two, largely ineffective committees involved – members of the gentlemen’s committee, who looked after finances, and the lady’s committee responsible for staffing.
The way she went about getting her own way is interesting. In a letter to her father, she wrote:
[W]hen I entered into service here I determined that, happen what would, I never would intrigue among the committee. Now I perceive that I do all my business by intrigue. I propose in private to A., B. or C. the resolution I think A., B. or C. most capable of carrying in committee and then leave it to them. And I always win. I am now in the heyday of my power. [4]
The first few months were chaotic and draining on Florence. The workmen doing the renovation hadn’t completed their work properly, there was no money left to run the hospital and staff were leaving or were unsatisfactory performers.
By early 1854 Florence had the establishment under control. She then started to look around at the situation in other hospitals to evaluate the quality of their nurses. She still believed there was a need for better training of nurses.
Her final report to the committee was made in August 1854 and she resigned shortly after.
Her long apprenticeship was now over she was about to enter a new phase in her life.
The Crimean War (1854-56)
The Crimea has long been disputed territory as it still is to this day. The decline of the Ottoman Empire during the 18th and 19th centuries saw other powers try to take advantage of the situation and gain more territory. In 1793 Russia had annexed the Crimea Peninsula and by 1853 was moving south with the aim of taking over Constantinople. If that happened Britain feared Russia would move towards India and Asia.
In July 1853 Turkey, with the backing of Britain and France, declared war on Russia. In March 1854 Britain and France also declared war on Russia. Britain was not well prepared for this war, as Irish author, Sue Goldie identified:
The hopelessly inadequate planning and organisation of the expedition became apparent as soon as the troops arrived at Constantinople. They landed at Gallipoli and Scutari, where they found themselves in competition for quarters and services with the French, who had already appropriated the best of everything. The French seemed to be far better organized . . .[5]
Before a shot was fired 20 percent of the British troops were incapacitated with cholera, dysentery and diarrhea. Almost 1,000 had died by August.
The first engagement by the British army with the enemy was on the banks of the Alma River on 20 September. The Battle of The Alma was a victory for the British but the losses were heavy according to the report by The Times (London) correspondent, William Howard Russell, published on 9 October:
Our victory has been glorious … but there has been a great want of proper medical attention; the wounded were left, some for two nights, the whole for one, on the field. From the battle they have been bundled on board ship by 600 and 700, without any proper means for removing the wounded from the field … The number of lives which have been sacrificed by the want of proper arrangements and neglect must be considerable.[6]
In previous wars, what actually took place on foreign soil would be largely unknown to the British public. This was the first war where there were reporters on the ground.
The Times correspondent based in Constantinople, Thomas Chenery, was also on hand to witness the debacle. He gave graphic details of the problems at the army’s Scutari Hospital in his report published on 12 October:
It is with feelings of surprise and anger that the public will learn that no sufficient preparations have been made for the proper care of the wounded. Not only are there not sufficient surgeons that, it might be urged, was unavoidable; not only are there no dressers and nurses that might be a defect of system for which no one is to blame; but what will be said when it is known that there is not even linen to make bandages for the wounded ? The greatest commiseration prevails for the sufferings of the unhappy inmates of Scutari, and every family is giving sheets and old garments to supply their wants. But why could not this clearly foreseen want have been supplied? . . . Has not the expedition to the Crimea been the talk of the last four months? . . . And yet, after the troops have been six months in the country, there is no preparation for the commonest surgical operations! . . . it rests with the Government to make inquiries into the conduct of those who have so greatly neglected their duty.[7]
These reports were of great embarrassment to the British Government. Formal inquiries would go on for years with the active involvement of Nightingale. In the meantime, something had to be done regarding supplying competent nurses for the war effort.
The following day another letter from Chenery expressed anger at the treatment of sick and wounded compared to the way the French looked after their wounded. “Their medical arrangements are extremely good,” he wrote, “their surgeons more numerous, and they have also the help of the Sisters of Charity, who have accompanied the expedition in incredible numbers. These devoted women are excellent nurses.”[8]
Florence Nightingale’s Journey to Scutari
Florence Nightingale was immediately moved to organize a volunteer effort by these news reports. Within days she had a plan in place to leave for Constantinople with three or four women.
On 14 October she wrote to Lis Herbert informing her of her intentions and asking for advice from her husband, Sidney Herbert, who now held the powerful government position of Minister at War.
By coincidence, Sidney Herbert was also responding to the news reports and wrote to Florence on the same day asking if she would be willing to superintend a Government-sponsored group of nurses at the Scutari military hospital:
I receive numbers of offers from ladies to go out, but they are ladies who have no conception of what an hospital is, nor of the nature of its duties. . . . There is but one person in England that I know of who would be capable of organizing and superintending such a scheme; and I have been several times on the point of asking you hypothetically if, supposing the attempt were made, you would undertake to direct it. . . . Your own personal qualities, your knowledge and your power of administration, and among greater things your rank and position in Society give you advantages in such a work which no other person possesses. [9]
Herbert and Nightingale worked together in planning for an expanded group of volunteers. Florence wanted to limit the number to 20, but in the end a total of 38 nurses left London on 21 October. Of these, 14 came from various English hospitals and 24 were Roman Catholic and Anglican Sisters.
Nightingale was well known in society circles but unknown to the general public. This was about to change when announcements were made of the expedition she would lead. The papers were gushing in their praise of this ‘graceful, rich, and popular’ young lady:
[T]here is not one of England’s proudest and purest daughters who at this moment stands on so high a pinnacle as Florence Nightingale.[10]
This was the beginning of the heroine myth which Nightingale herself abhorred. But there was no way she could stop it.
The fund The Times set up asking for donations was bringing in money due to the Florence Nightingale name and the stories meant other women were clamoring to volunteer as well.
Florence Nightingale’s arrival in Scutari
Scutari is a district on the Asian side of Constantinople (now Istanbul). The hospital used by the British Army during the Crimean War was previously a Turkish army military barracks. It was, and still is, an imposing building built on sloping land, rectangular in shape with a parade ground in the centre.
Scutari Barracks Hospital in Turkey[11]The party arrived in Scutari on 4 November and immediately got to work. Conditions were far worse than what they were expecting, as Rosalind Nash, a niece of Florence Nightingale, described:
[The hospital] had been transformed from a barrack by the simple process of an application of whitewash, and underneath its imposing mass were “sewers of the worst possible construction, loaded with filth, mere cesspools in fact, through which the wind blew sewer air up the pipes of numerous open privies into the corridors and wards where the sick were lying.” Wounds and sickness, overcrowding and want of proper ventilation added to the foulness of the atmosphere. At night it was indescribable. The wards were infested with rats, mice and vermin. Flooring was defective, furniture, and even the commonest utensils for cleanliness, decency and comfort, were lacking. The canvas sheets supplied were too coarse to be used for the wounded and emaciated men. There were not enough bedsteads. Surgical and medical appliances were often not to be had, and the cooking arrangements were devised for ordinary meals only.[12]
From day one, they were inundated with streams of casualties, as many as 800 in one day. A major difficulty was the availability of supplies due to the inefficiency and obstruction by the Army’s Purveying department. She used her own money and money from The Times fund to source desperately needed supplies.
The work in cleaning and getting the hospital on to a solid footing was exhausting. It wasn’t helped by many of the nurses who were not up to the challenge and by some of the senior Army doctors who were against any women being around. Some of the nuns also refused to take orders from Nightingale.
John Macdonald, the trustee of The Times fund, worked closely with Nightingale in providing needed stores. Upon returning from visiting the hospital in February 1855, he wrote this description of her:
She is a “ministering angel” without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds. . . . She has frequently been known to stand 20 hours on the arrival of fresh detachments of sick, apportioning quarters, distributing stores, directing the labours of her corps, assisting at the painful operations where her presence might soothe or support, and spending hours over men dying of cholera or fever. Indeed, the more awful to every sense any particular case might be the more certainly might be seen her slight form bending over him, administering to his ease by every means in her power, and seldom quitting his side till death released him.[13]
From this and other news reports and poems she became a cultural icon. The Florence Nightingale mania in England continued unabated during 1855. She considered the ‘vanity and frivolity’ harmful to the cause because it lowered the standing of nurses in the eyes of the ‘medical men’, while at the same time attracting women to hospitals who were simply ‘desirous of notoriety’.[14]
During the first six months much had been achieved in improving conditions in the Scutari hospital. The death rate had been reduced markedly, from 43 percent in February to 2 percent of admissions by May.[15]
How had she achieved so much in such a short time? In a ‘warts and all’ critique of Nightingale, Lytton Strachey acknowledged her contributions:
It was not by gentle sweetness and womanly self-abnegation that she had brought order out of chaos in the Scutari Hospitals, that, from her own resources, she had clothed the British Army, that she had spread her dominion over the serried and reluctant powers of the official world; it was by strict method, by stern discipline, by rigid attention to detail, by ceaseless labour, by the fixed determination of an indomitable will.[16]
Florence Nightingale in the Crimea
In May 1855 Nightingale travelled to the Crimea to inspect the medical facilities there. She found them to be wanting and run unprofessionally, but she had no authority from the War Department to intervene. This authorization would be delayed until March 1856, just before the war ended.
It was while she was there that she came down with a debilitating illness that would plague her for the rest of her life. After recovering from this first attack she returned to Scutari several weeks later but was unable to resume her duties at the hospital for some months.
Back at work, she continued to look after the welfare of her patients even as their physical needs were provided for. She now went about attending to their mental and spiritual needs by setting up reading and recreation rooms and by initiating classes and lectures. This was unheard of for a military hospital and officers critisised her for “spoiling the brutes.”[17]
After her day’s work she would sit in her office and write the hundreds of letters to the relatives and friends of soldiers. There were official documents to deal with besides her own private letters where she could give the true picture of the weird world she was living in. She would also fill pages with recommendations and statistics analyzing the complex organizational and health issues. These would prove to be of immense value for the official enquiries to be held in years to come.
During the second half of 1855 plans were set in motion for a national appeal to recognize the ‘noble exertions of Miss Nightingale in the hospitals of the East’. In November the appeal was launched and when it closed six months later over £44,000 had been given.[18]
Meanwhile, as the war came to a close, she worked non-stop. The undermining of her by medical staff and senior army officers in the Crimea continuing unabated.
The Treaty of Paris, formally ending the Crimean War, was signed on 30 March 1856. Nightingale’s role was to gradually close down the Scutari hospital.
She sailed from Constantinople for home on 28 July 1856, travelling as ‘Miss Smith’ to avoid being recognized. She finally met up with her family on 7 August, 657 days after her departure. She was weary and exhausted from her experience and in the last year there were times when she had been close to death.
Overall there had been 4,000 deaths of British soldiers from battles and 16,000 deaths from disease. She thought she had failed, but in fact she returned as a national heroine.
Through her unwavering approach for the need for sanitation, she clearly demonstrated it saved lives – well before Louis Pasteur’s germ theory emerged in the 1860’s. Earlier, Hungarian physician Ignác Semmelweis had discovered in 1847 that if surgeons washed their hands after performing autopsies, then other patients would not contract transferrable diseases. Both Nightingale and Semmelweis were ridiculed by most doctors for their ‘crazy’ ideas because everyone ‘knew’ that it was miasma (an illness-carrying vapour) that caused infections.
Another phase of her life was over with the most important part yet to come in her remaining years.
Notes
- Jerry Barrett, “The Mission of Mercy: Florence Nightingale Receiving the Wounded at Scutari,” 1856, Painting. Source: “The Mission of Mercy: Florence Nightingale receiving the Wounded at Scutari,” National Portrait Gallery, modified 29 November, 2017, accessed 29 November 2017, https://www.npg.org.uk/collections/search/portrait/mw08508/The-Mission-of-Mercy-Florence-Nightingale-receiving-the-Wounded-at-Scutari.
- Cecil Woodham-Smith, Florence Nightingale: 1820-1910 (New York: McGraw-Hill Book Company, 1951), 36.
- Woodham-Smith, Florence Nightingale, 74.
- Lynn McDonald, ed. Florence Nightingale: An Introduction to her Life and Family (Waterloo, Ontario, Canada: Wilfrid Laurier University Press, 2002), 327.
- Sue M. Goldie, ed., Florence Nightingale: Letters From The Crimea 1854-1856 (Manchester UK: Mandolin, 1997), 15.
- Goldie, Florence Nightingale, 17.
- Edward Tyas Cook, The Life of Florence Nightingale, Volume 1 (London: Macmillan and Co., 1913), 146.
- Cook, Life of Florence Nightingale, 147.
- Cook, Life of Florence Nightingale, 153.
- Cook, Life of Florence Nightingale, 165.
- Unsigned, “Barracks at Scutari – The British Hospital,” 1855, Wood engraving. Source: “Crimean War, Turkey: cityscape view showing the barracks and hospital at Scutari,” Wellcome Collection, accessed 20 December, 2017, https://wellcomecollection.org/works/ku6tsnv2?query=Barracks+at+Scutari+.
- Rosalind Nash, A Short Life of Florence Nightingale: Abridged from the Life, by Sir Edward Cook with additional matter (New York: The Macmillan Company, 1925), 87.
- “Florence Nightingale Times Obituary,” Vauxhall History, accessed December 15, 2017.
http://vauxhallhistory.org/florence-nightingale-times-obituary/ - Mark Bostridge, Florence Nightingale: The Woman and Her Legend (London, Penguin Books, 2009).
- David Bornstein, How to Change the World: Social Entrepreneurs and the Power of New Ideas (Oxford: Oxford University Press, 2007).
- Lytton Strachey, Eminent Victorians (Garden City, N.Y.: Garden City Publishing Co., 1918), 156.
- Strachey, Eminent Victorians, 160.
- Bostridge, Florence Nightingale.