Florence Nightingale fought to introduce nursing and medical care reforms into British military hospitals during the Crimean War, which resulted in better care for ill and wounded soldiers and led to civilian hospital reforms in Great Britain.
In 1854, when Great Britain entered the Crimean War (1854-1856), Florence Nightingale was already an experienced nurse. The horrible medical conditions that were developing in the military hospitals at Scutari had been brought to the attention of the British public in The Times of London
On November 4, 1854, Nightingale and the other nurses arrived at Barracks Hospital, where they faced a nightmare. Army barracks had been hastily converted into a hospital to accommodate more than eighteen hundred wounded soldiers after the Battle of Alma on September 20. More patients arrived after the Battle of Balaklava in late October, and 2,300 additional casualties arrived after the Battle of Inkerman in early November. Soldiers were packed into wards and placed on pallets in the corridors. The nearby general hospital housed an additional nine hundred or so wounded. Both hospitals were severely overcrowded, chaotic, and filthy. Wounded soldiers were cared for by untrained orderlies who were expected to cook, clean, and nurse. There was so much for them to do, that they could accomplish very little.
John Hall
Nightingale’s first hospital reforms were administrative, and for good reason. The conditions she found at Scutari were appalling. Cesspools lay just under the floorboards, many of which were so rotten they could not be scrubbed. The walls were crusted with filth, and there were vermin everywhere. The building was far too small to house the enormous numbers of casualties. The toilets were overflowing, the large tubs used in the wards were emptied once every twenty-four hours only, and there were very few chamber pots. The soldiers were blood-soaked, mud-encrusted, half-naked, ill-fed, and infested by lice, as were their bed linens and clothes. The hospital had no ventilation system, and the stench was horrendous.
Cartoon by John Leech (1817-1864) decrying the wretched conditions faced by British soldiers in the Crimea. The first soldier says, “Well, Jack! Here’s good news from home. We’re to have a medal.” The second soldier replies, “That’s very kind. Maybe one of these days we’ll have coat to stick it on!”
The supply of provisions was equally inadequate. Before Nightingale left London, she had been assured by the army medical board that the Scutari hospitals were being fully supplied. In reality the hospitals lacked almost everything. They had no candle holders, wash basins, towels, soap, brooms, mops, trays, plates, scissors, or cutlery, and barely had fuel. Stretchers, splints, bandages, and even the most regularly used drugs were unavailable. Replacement supplies did not arrive or were tied up in bureaucratic red tape and thus inaccessible. Nightingale distributed the provisions she had brought along and purchased additional items with her private cash fund. She soon had a government storehouse installed to receive and distribute goods. She also forced the orderlies to empty the wooden tubs, and to scrub floors and walls with disinfectant. Next she turned her attention to the kitchens.
Nightingale reorganized the kitchens and tackled the badly cooked, irregular meals. Under her new plan, the meals were well cooked, appetizing, and served on a regular schedule. She also created an extra kitchen to provide the soldiers with strengthening foods such as beef tea, calves’ foot jelly, custards, rice puddings, and wine, all of which Nightingale provided from her own stores.
The Scutari hospital laundries were in deplorable condition as well. In three months, only seven shirts had been laundered. The hospital linens were washed in cold water and returned to the soldiers filthy and infested with lice. Nightingale rented a Turkish house, installed boilers, and employed soldiers’ wives as launderers. She funded this venture with a combination of her own money and funds from The Times of London
John Cameron Macdonald
Nightingale’s position as superintendent of nursing was official, but it was her duty to provide nursing services when requested by army physicians. Hall scoffed at the idea of an army nurses corps and, at his instigation, many doctors refused to use the nurses. However, some did, allowing Nightingale and her nurses to demonstrate their worth. The nurses received soldiers, dressed wounds, attended compound fractures, fed the seriously ill, and read to and wrote letters for the soldiers. They made pillows, padded splints, and slings. They also had to wash their own hands and faces during the day, and use hot water and soap to bathe their patients. Nightingale insisted that the nurses obey the nurse superintendent and behave in a respectable manner, ensuring a workable chain of command, organized nursing duties, and real patient care.
Nightingale nursed many of the worst cases herself and also attended operations. The hospitals did not have operating rooms, so all surgeries were performed in the wards, in full view of the other wounded, and without anesthesia. She immediately purchased several operating tables and privacy screens, and convinced Hall
Nightingale’s imposition of order, her insistence on sanitary conditions and cleanliness, her supplies, and her trained nurses cut the mortality rate from 42 to 22 percent in the first six months. Because more soldiers recovered rather than died, Nightingale instituted reading and recreation rooms to help with their rehabilitation. She also organized classes and lectures. As a result, the private soldiers began to drink less and save their pay. Seizing this opportunity, she began to help them send their pay home; £71,000 was sent home in a six-month period. The lot of wounded and hospitalized soldiers improved immensely under Nightingale’s hospital reforms.
Florence Nightingale knew that poor sanitation and filth, poor room layouts and designs, and incompetent hospital administration made it impossible to nurse and care for the injured. Her nursing reforms were inspired by the practices in religious nursing orders. Nightingale was remarkable because she brought those effective practices to public attention and insisted that her nurses, and the British military’s medical corps, adhere to and implement them.
Through the fame she gained in the Crimea, Nightingale attracted reliable, respectable, young women to the nursing profession. She also developed ideas for training and supervising hospital nurses, which became the cornerstone of her work after her return from the Crimea. Once back in England, she set up a professional nurses training program at St. Thomas Hospital in London.
Nightingale also successfully introduced female nurses into the military and won her battle to have soldiers at the lower ranks recognized as human beings, treated as such, and given the basic necessities of life. She knew that better treatment not only saved lives but also created better soldiers. Her work, reforms, and reports on the conditions of army hospitals of the Crimean War led to a new army medical school, the use of chloroform during surgeries, and the development of new surgical techniques, which all led to the field of modern nursing.
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Baly, Monica E. Florence Nightingale and the Nursing Legacy. 2d ed. London: Whurr, 1997. Baly presents a detailed discussion of the effects of Nightingale’s experiences, work, and nursing reforms while in the Crimea. -
Goldie, Sue M., ed.“I Have Done My Duty.” Florence Nightingale in the Crimean War, 1854-1856. Manchester, England: Manchester University Press, 1987. This work presents Nightingale’s letters to family, friends, and supporters, accompanied by narration and analysis and chronicling her work and reforms during the Crimean War. -
Nightingale, Florence. Florence Nightingale: An Introduction to Her Life and Family. Vol. 1 in The Collected Works of Florence Nightingale, edited by Lynn McDonald. 16 vols. Waterloo, Ont.: Wilfrid Laurier University Press, 2001. The first volume of this sixteen-volume collection contains essays examining Nightingale’s life and the themes found in her work, as well as selected correspondence and some of Nightingale’s writings. Subsequent volumes contain her correspondence, journals, diaries, and other writings about a wide range of subjects, including theology, mysticism, public health care, hospital reform, and the Crimean War. -
O’Malley, I. B. Florence Nightingale, 1820-1856: A Study of Her Life Down to the End of the Crimean War. London: Thornton Butterworth, 1931. This work includes comprehensive information and descriptions of the conditions of the military hospitals at Scutari and how Nightingale fought for changes and reforms in the treatment of the soldiers there. It also offers a detailed look at nursing before and after Nightingale arrived. -
Small, Hugh. Florence Nightingale, Avenging Angel. London: Constable, 1998. Small’s work offers a detailed chapter on the horrors Nightingale faced in the Scutari hospitals and how she came to reform medical and nursing practices.
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