Florence nightingale and her contribution to nursing

In the Dickens book “ Martin Chuzzlewit” the character Mrs Gamp a nurse, was dirty, fat, and old and also a drunk, which was like most nurses of those days before Nightingale. One can say that because of this, nursing was not seen as a highly regarded profession. Source A supports the view of Mrs Gamp being a true portrayal of nurses in the 1800s.

It is an article from the Telegraph by Robbie Collin, he is writing about the character Mrs Gamp and he says “ Dickens wrote that Mrs Gamp was, ‘ four-and-twenty years ago, a fair representation of the hired attendant on the poor in sickness,’ and she was so popular with Victorian readers that it took Florence Nightingale’s efforts in the Crimea to steer the public perception of nurses away from the Gamp stereotype”.

Dickens published this book in parts between 1843-1844 and thought of the character Mrs Gamp as ‘ highly realistic’ and used the description of a nurse from his friend, Angela Burdett-Coutts1, when creating Mrs Gamp’s characteristics. This gives an insight as to what nurses were like pre Florence Nightingale and how she made a drastic change to the perception and status of nurses. In the early 1800s most hospitals were dirty, unsanitary and poorly planned buildings. Nurses were usually uneducated in medicine, and did not have much experience in the field2.

They were almost always uncouth and ignorant, as well as being drunks and prone to promiscuity. Florence was told by the head nurse in a London hospital that she “ had never known a nurse who was not drunken” and that most of the nurses engaged in “ immoral conduct” with the patients in the wards3. They were either servants from working class backgrounds or predominantly Catholic nuns. People didn’t go to hospitals, unless they were poor, wealthier people had nurses in the home, and in the main they were seen as servants.

It was possible for the wealthy to call for a doctor to come to their house as doctors were employed privately. There was a common idea that it was actually dangerous to go to hospital. Florence Nightingale states, “ It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. ” The ‘ Augustinian Sisters were the only model for public nursing until the 1800s. ’4 When proper training for nurses became available during the late 1700s to early 1800s at the Deaconess Institute at Kaiserworth in Germany (1836) and following that other institutes opened around Europe.

Yet the majority of nurses in England were still poorly educated in medicine as most of them didn’t go to these institutes during the early 1800s. The reasons could have been that they could not afford to travel to get the education needed or it was thought unnecessary. Many nurses at the time were illiterate. It is not certain as very little of nurse’s history is known. Florence Nightingale changed this by showing that education was crucial. Source B is a snippet from a letter where Florence Nightingale is giving advice to her students. She states “ But what does honour lie in?

In working hard during your training to learn and to do all things perfectly”. This shows dedication and encouraging the other nurses to be dedicated and succeed and that she knows nurses need formal training and qualifications if they are to get a job required of them. In hospitals in England or war hospitals, there was generally no hand washing, the equipment was not cleaned between patients and patients were not bathed regularly or properly5. In these hospitals soldiers died of infections caught there rather than dying on the battlefield.

A clear example of this was at Scutari during the Crimean war, where Florence became notorious for her nursing. 4, 077 soldiers died during her first winter before improvements were made. She then reduced the death rate from 42% to 2% by making improvements in hygiene6. Cleanliness and hygiene were reassessed when Florence Nightingale explained to the army using statistics that if she was given cleaner hospitals the injured soldiers would recover quicker and then get back to fighting7.

Source C is a diagram that shows the large amount of deaths in the winter and then the decreasing number of deaths after reforms were made. Florence was unlike many middle class women; she was well educated by her father and received a better education than most girls would have done at that time. She thought of it as unfair that women did not have the same opportunities as men. As she grew up she became very fond of looking after the ill and became interested in the work of hospitals, which led to her visiting hospitals in London to investigate the occupations for women there.

Her visits lasted for eleven years. On a journey from Paris she met two St. Vincent de Paul sisters. They introduced her to their convent at Alexandria9, which she visited and saw how well organised these sisters were compared to nurses in England. However it was her visit to the Deaconess Institute at Kaiserworth that gave her the inspiration to make nursing a vocation for women. Where she spent four months training as a sick nurse in 1851.

On her return to England she was determined to change the nursing profession. ‘ She herself saw her mission in larger terms: to serve humanity through the prevention of needless illness and death’11. After returning to England she became superintendent at the hospital for Invalid Gentlewomen and then in 1853 when the Crimean war broke out, she and thirty-eight nurses went over to look after wounded soldiers12. This is where Florence excelled in nursing and received the famous title ‘ Lady with the lamp’.

This is also where she started collecting and collating statistics in order to show that cleaner hospitals caused fewer deaths, ‘ Nightingale recognized that reliable data on the incidence of preventable deaths in the military made compelling arguments for reform’13 after that she continued to use statistics in helping her arguments about health reform, Nightingale saw it as the best way to win them. Statistics were not usually used at that time but Florence understood the power of diagrams and pictograms in giving impact and a clear understanding of number, at a time when many were illiterate.

This made her arguments much more powerful. She next turned her attention to India and worked on a sanitary reform for the next 13 years or so trying to reduce the mortality rate. However, she was doing this all from England as she was still recovering from the Crimean fever she contracted at Scutari. In 1860, for her contribution to Army statistics and comparative hospital statistics, she became the first woman to be elected a fellow of the statistical society. She then established the Nightingale Training School for nurses at St. Thomas’ hospital, London.

It attracted middle class women because it made the nursing profession more respectable. In 1881, according to the census, there were 35, 715 trained nurses14. This shows the drastic change Florence made in nursing because she made it a respectful profession with nurses having the correct training and encouraging women to become a nurse. In 1859 she published the well-known book “ Notes on Nursing”. Which is still in print, available today and very popular, it is sold worldwide and has been translated into eleven different languages.

It is a very influential book and it is still used as a reference today by modern women training to be nurses15. Although Florence was predominantly bed ridden during the 1860s she did not stop working. She kept a watchful eye on the nurses at her training school, whilst working on setting up home nursing and the works of rural hygiene, deaths in childbirth and the Indian sanitary question. She did all of this from her house No. 10 South Street, London. Mr Whitfield, the man who helped her set up the nursing school at St Thomas’ hospital, gave a suggestion as to who should be the superintendent.

“ He appreciated that the state of Florence’s health made it unlikely that she would ever be able personally to superintend the school” 16. He therefore suggested that the matron of St Thomas’ hospital should become the superintendent of the Nightingale training school for nurses. This was Sarah Elizabeth Wardroper, although she had no experience in nursing she too was very well educated and had been a good matron. Florence was reluctant at first but after much negotiation she agreed that Mrs Wardroper would be the superintendent17.

As well as the nursing profession, Florence Nightingale also made reforms within the hospitals as they are seen as a whole. The respectable nursing profession would not have made a difference in curing patients if reforms within the hospital were not made. In the post war period Florence studied new designs for hospitals in order to help reform in health and sanitary systems18. From her research she wrote Notes on Hospitals, published in 1859. She addressed all aspects with close detail. For example iron bedsteads to replace the wooden ones and switching to glass cups rather than tin cups19.

She found a ‘ revolutionary’ design for hospitals in Paris; it was separate units that made up large hospitals. She saw that by making each pavilion a light and airy self-contained unit, it reduced the spread of infections. She was successful in bringing this design to England and started to change the way hospitals were into the basis of what hospitals are like today20. To show this change is source D and E. Source D is an illustrated picture of Florence in Scutari wit the iconic ‘ lamp’ and her caring for soldiers. Source E is a picture of one of the wards in her training school at St Thomas’ Hospital.

Comparing these two images you the colossal change between them. In the wards in Scutari it was dark, no ventilation, no windows for light or air and all the beds were so close together. You can see from source D why there was a lot of spread of disease amongst the soldiers. However source E is completely different. All the beds are spaced out, with plenty of windows, lots of ventilation and even plants to create fresh air. The patients are in proper beds with plenty of nurses attending to them, where as in source D there is only Florence – she was the only nurse to work late at night – and the soldiers are not in proper beds.

Whether this is a factual portrayal of the barracks in Scutari is uncertain as source D is just an illustration but we must rely on it as it is the only way to see what conditions were like in Scutari and in doing that see the differences compared to hospitals today. Although Florence is not solely responsible for bringing about these changes, she plays a big part in it because she did push very hard in order to make changes to not only the nursing system but also the whole medicine profession in general.

She did all of this by making very valid and convincing arguments whilst, of course, using lots of statistics. People seem to forget the other significant nurse of the Crimean war, Mary Seacole. The Jamaican nurse applied to go to Crimea when she fist heard about the cholera epidemic but was refused by the British army and was then rejected in joining Florence Nightingale’s team of nurses. This discrimination did not stop Mary from going to Scutari; she used her own money to get there. She visited the hospital where Florence was in charge but her help was refused.

However even then Mary did not accept defeat and started her business the ‘ British Hotel’, a few miles from the battlefront. She provided soldiers with food and drink. With the money she earned from this she was able to buy medical equipment in order to treat soldiers. She was treating soldiers on the battlefield, which none of the other nurses were doing. She was seen attending to soldiers from both sides whilst the battle was happening. Source F also backs this up, from the magazine ‘ The Advertiser’ where it is stating how Mary goes to the front line to look after wounded soldiers.

Mary Seacole became known as ‘ Mother Seacole’ and “ her reputation rivalled that of Florence Nightingale” 21. Mary had written a book after returning from Scutari called ‘ The Wonderful Adventures of Mrs Seacole in many lands’, published in 1857. She was also awarded a Crimean medal and a statue was made of her but the rest of her life was lived in destitute and was forgotten. The reason as to why Mary this was that not long after returning to England was because she was bankrupt and was unable to contribute change to the nursing system, unlike Florence she made no real significant change.