Crimean war 1853—1865

Shortly after the start of the 1853 Crimean War (in which Britain, France, Turkey, and Sardinia fought Russia for control of access to the Mediterranean from the Black Sea), information about the neglect and poor care of casualties began to reach England. A correspondent for the London Times newspaper wrote vivid accounts of the deplorable conditions and lack of medical and nursing care for the British troops. The Sisters of Mercy tended Russian troops, the Sisters of Charity tended the French, and the wounded of England were almost completely neglected. The correspondent’s charges were so persistent that a commission was sent to investigate. As a result, the Secretary of War decided that England, too, should have a group of women nurses to tend the war casualties.

The Secretary of War contacted Florence Nightingale and explained the situation to her. Because she had both nursing and administrative experience, the secretary perceived her as the one nurse in England capable of organizing and supervising care in a foreign land.

Being appointed to the task organizing and supervising nurses during the Crimean War gave Nightingale an unexpected opportunity for achievement. She left for Crimea, taking with her 38 self-proclaimed nurses of limited experience, 24 of whom were nuns. On arrival, they found overcrowded, filthy hospitals with no beds, no furniture, no eating utensils, no medical supplies, no blankets, no soap, no linens, and no lamps. Wounded soldiers lay on the filthy floor in their battle uniforms (Figure 7-1). Soldiers were more likely to die from infected wounds than the wound itself. Nightingale took charge. Using the supplies she brought, and raising funds, she purchased supplies that doctors could not obtain for the army. Nightingale hired people to clean up the “hospitals” and established laundries to wash linens and uniforms and prepare nutritious meals. She expected a great deal of herself and those who worked with her. It was not an easy task. A major prejudice that had to be overcome was that of medical officers, who considered the nurses intruders. The hours were long and difficult for Nightingale and her nurses. An additional concern was that sometimes nurses became more involved in converting patients to their particular faith than in giving general care. Nightingale hired tutors to teach convalescing soldiers how to read and write. Many soldiers had family following them, and recreation rooms were set up for their use. She believed that the best nurses were those who had good character, who experienced a sense of calling, and who were well trained to meet the physical needs of patients. The barracks, a 4-mile labyrinth of cots meant for 1700 patients, packed in 3000 to 4000 patients. She did not want her nurses on the wards after dark and could often be seen after hours making additional rounds with her lamp to check on patients. The soldiers fondly referred to her as “Birdie.” These extra efforts earned her the title “the Lady with the Lamp” as immortalized in Longfellow’s poem “Santa Filomena” (Box 7-1).

Mary seacole; honored for her work

Nightingale had help during many of those nights. Mary Seacole, a nurse from Jamaica, also played an important role in the history of nursing. She used her own money to build a lodging house in Crimea and turned the second floor of it into a hospital, where she nursed the soldiers. Seacole was especially knowledgeable about tropical medicine and used herbs and natural plant medicines to treat patients with cholera, yellow fever, malaria, and diarrhea. At the end of her day, she would go to the barracks hospital and offer her help to Nightingale. They worked side by side caring for the soldiers. Both Seacole’s government and the British Commonwealth honored her for the lives she saved (Cherry and Jacob, 2011).

Death rate drops; nightingale decorated

After 6 months, it was obvious that the efforts of Nightingale and her nurses were paying off. The death rate among the wounded dropped from 420 deaths per 1000 casualties to 22 per 1000. She stayed through the war and was the last to leave. Many of her nurses had become ill during the war and were sent home to recover. Nightingale became ill with Crimean fever, probably typhus, and almost died. When she returned home, Queen Victoria decorated her for her efforts in the war.

Nightingale establishes first school of nursing in england

One of Nightingale’s major goals was to establish a school of nursing in England. An overwhelming number of physicians opposed such a school. Their opposition was that “because nurses occupied much the same positions as housemaids, they needed little instruction beyond poultice making, the enforcement of cleanliness, and attention to their patients’ personal needs” (Kalish and Kalish, 1995). In 1860, Nightingale established the Nightingale Training School at St. Thomas Hospital in England. It was a 1-year program. She chose this site because of the hospital’s reputation for progressive medical care. The school was independent from the hospital and financially independent as well. She believed nurses should work only in hospitals, not in private duty. Nightingale had strict admission standards that emphasized high moral character and intelligence. She was strict with her nursing students. They were locked up at night as a way to assure the middle-class parents that their daughters were safe from harassment. Upon graduation, she gave the nurses gifts of books and invited them to tea. When her graduates went to work in far-off places, she sent flowers to welcome them to their new home (Romanoff, 2006).

Nightingale’s personal and nursing decisions reflected the influence of works by Plato and Hippocrates. Examples include her decision to remain single, her sense of mission, her concern with patient environment, her focus on the whole patient, and her belief in the need for keen observation and assisting nature to heal the patient (LeVasseur, 1998). Nightingale wrote over 200 publications, the most famous of which is Notes on Nursing. Although she was reclusive, she was influential in matters of military and public health policy because she kept such precise notes, which included statistics. She even advised the American secretary of war how to set up hospitals for the wounded during the Civil War.

Nightingale’S core belief about nursing

The core of Nightingale’s spirituality was a belief in perfection. To her, nursing was a sacred calling, a commitment to work for mankind, not a business. Other Victorian women like her shared the sense of the sacredness of time and belief that wasting time was a sin. Nursing became a way for Florence Nightingale to work toward the perfection of mankind and her personal salvation. She was against licensure. To her it was too much like nurses being in a union. She eliminated prejudice against a better class of women entering nursing and created a push toward the development of nursing as a respectable vocation.

Nightingale was intelligent, well educated, and skeptical. This combination made her the foremost critic of the meaning of nursing and the nursing role. She continued to be involved in health policy well into her eighties. She was the first woman to receive the Order of Merit from the King of England. In 1910, she died in her sleep of heart failure at age 90. The government offered to bury her at Westminster Abbey, but according to her wishes, she was buried in the family plot at East Wellow, Hampshire. The marker reads, “F.N. Born 12 May 1820. Died 13 August 1910.”

In 1893, Lystra Gretter, the principal of Farrand Training School in Detroit, and a committee modified the Hippocratic Oath. They named it the “Nightingale Pledge” as a token of esteem for the founder of modern nursing. It continues to be recited in many schools during graduation, primarily because of the mistaken belief that Nightingale wrote it. It reads as follows:

Nightingale museum on the site of her school of nursing

In the spring of 1989, the Florence Nightingale Museum opened in London on the grounds of St. Thomas Hospital, the site of the Nightingale School of Nursing. The museum is a tribute to this nursing leader, despite the fact that she wrote in her journal, “I do not wish to be remembered when I am gone.” Despite her great and courageous contributions to nursing, Florence Nightingale saw only her own faults and her failures.

Civil war (1861—1865)

In the 1800s, women who worked in hospitals, particularly in the South, were victims of deep prejudice from men in general and especially from the medical profession. As one southern woman put it, “It seems strange that what the aristocratic women of Great Britain have done with honor is a disgrace for their sisters on this side of the Atlantic to do” (Kalish and Kalish, 1995).

Casualties were high on both sides during the Civil War. Many soldiers died right on the field, and others died because of a poorly trained medical corps. Southern women offered their services as volunteers, but most of the nursing was done by infantrymen assigned to do a task they did not want to do. It was many months before the Confederate government recognized southern women for their contributions (Figure 7-2).

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