Volume I Part 35 (1/2)
THE HOSPITAL REFORMER
(1858-1861)
It e principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm It is quite necessary, nevertheless, to lay down such a principle, because the actual e crowded cities, is very her than any calculation founded on thepatients treated _out of_ hospitals would lead us to expect--FLORENCE NIGHTINGALE (1863)
The work for the health of the soldiers, which has been described in the preceding Part, filled the larger part of Miss Nightingale's life during the five years after her return from the Crimean War; and in 1856, 1857, 1858 it occupied nearly the whole of her time The work lasted for almost exactly five years, froust 1856) to the day of Lord Herbert's death (August 1861) But into those strenuous years Miss Nightingale had crowded much other work besides It has been necessary, for the sake of clearness and coherence, to treat the subject of Arle Part In the present Part the otherthe sa the years 1859, 1860, and 1861, will be described
The story of her life and work may be divided for convenience into separate Parts; but in her own mind each of the branches of effort into which successively she threw herself were connected parts of a larger whole Her experiences in the Crirew out of them, had caused her to throw her first efforts into the cause of reform in the interest of her ”children,” the British soldiers But all the time she saith entire clearness that the health of the Arer question; namely, the health of the whole population from which the soldiers are drawn She had made her reputation by work in military hospitals, and her first effort was to improve them, but she saw that the condition of civil hospitals was the larger and the more important matter And she saw further still that hospitals are at best only a necessary evil; a necessity, as soe of civilization The secret of national health is to be found in the homes of the people If in a particular town or quarter, for instance, there was excessive infant mortality, the re hout the world as a war-nurse; but she knew that the difficulties which she had encountered in that sphere were due to the fact that the art of nursing was so ill understood at home Her vision took wider scope, and her efforts to i of the people embraced, as we shall hear, both India and the Colonies Mr Disraeli, in a fa _Sanitas sanitatuale's e and the depth of her influence are considered, the claierated: she was ”the foree”[303] Our immediate concern is with her life and work, first, as a Hospital Reformer (Chaps I, II), and then as the founder of Modern Nursing (Chaps III, IV)
[302] At Aylesbury, Sept 21, 1864
[303] _Nutting_, vol ii pp 207-8
Miss Nightingale's authority on the subject of Hospitals ruled para the Crimean War--as the reference of the Netley plans to her has already indicated Popularity and prestige were confirmed by a practical experience which at the time was probably unique ”Have you,” she was asked by the Royal Coanization of civil and military hospitals?”
”Yes,” she replied, ”for thirteen years I have visited all the hospitals in London, Dublin, and Edinburgh, many county hospitals, soland; all the hospitals in Paris, and studied with the 's[oe]urs de charite'; the Institution of Protestant Deaconesses at Kaiserswerth, on the Rhine, where I ice in training as a nurse; the hospitals at Berlin, and many others in Germany, at Lyons, Rome, Alexandria, Constantinople, Brussels; also the war hospitals of the French and Sardinians” Her authority on the subject was strengthened yet more when her Papers, already mentioned,[304] which were read at Liverpool in October 1858, were, early in the following year, published, with additional et, in acknowledging a copy of the book, _Notes on Hospitals_, ”to be the most valuable contribution to sanitary science in application to medical institutions that I have ever read” The book has not been reprinted since 1863, and is now, perhaps, forgotten; but, if so, that is the necessary fate of otten when their work has passed into the accepted doctrine and practice of another In its day Miss Nightingale's _Notes on Hospitals_ revolutionized ave a new direction to hospital construction
[304] Above, p 383
Sir Jahtingale's work in this field Before she wrote, there was sad need of the application of sanitary science to many of our hospitals The rate of h Hospitals created alrene, hospital pyaemia, hospital erysipelas, hospital fever, and so forth It was even questioned whether great hospitals were not, and ale showed that there was no such necessity By the light of sanitary science, she traced back the excessive inal defects in the site, in the aggloe number of sick under the same roof, in deficiency of space, deficiency of ventilation, deficiency of light In a second section of her book, going more into detail, she enumerated ”Sixteen Sanitary Defects in the Construction of Hospital Wards,” adding to the stateestions of a remedy She added a series of equally detailed hints on hospital construction, illustrating them by careful plans, exterior and interior, of some of the best modern hospitals and of the worst old ones Some of my readers may be acquainted only with modern hospitals, and it will be well perhaps to describe the defects in the old style of hospital Many of the hospitals and infirale started her crusade, had been built with no consideration for the sub-soil, and the drainage of them was very imperfect The wards were sadly overcrowded, often as much as three or four times over, tried by the present standard of the number of cubic feet desirable per bed
Ventilation was defective The wards were often low There were frequently more than two beds between the s Little attention had been given to the supres which were non-absorbent The furniture of the wards, and the utensils, were such as would be condeale found it necessary to enter in some detail upon the desirability of _iron_ bedsteads, _hair_ lass_ or _earthenware_ cups, etc (instead of tin); as also upon that of sanitary forethought in the construction of sinks and other places
Hospital kitchens and laundries at home were not quite so bad as at Scutari; but many of the kitchens were still very priale were ”small, dark, wet, unventilated, overcrowded, so full of steaanic matter that it is hardly possible to see across the roo of the past; and the passing of it is due, in large , as her book did, with awith the prestige of a popular heroine, her _Notes on Hospitals_ opened a new era in hospital reform There had, it is true, been improvement before her time; and she was not the one and only discoverer of the simple principles which she enunciated, and which are now the A B C of the subject But the general level of thought or practice does not always rise to the height of the better opinion; it depends too often upon the average opinion of the day Moreover, in some matters, there was, at the time when she wrote, a conflict of principles, in which the victory was generally given to the wrong side The beneficial effect of fresh air was not always denied; but the advantage of securing war upon artificial methods of ventilation, was in practice considered paraale was a pioneer in the consistent eave to the supreme necessity of fresh air, and to the iht, except perhaps in certain ophthalmic and a small number of other cases”
She based her contention in these matters on scientific principles; she supported it from her experience and observation in the Crin hospitals In many quarters her ideas were new and revolutionary We have heard already what ”a bitter pill” it was to one eminent medical official of her day to s the idea of ”pavilions”
in hospital construction[305] Lord Palmerston explained in the House of Co the progress of science in every department, it was only within a few years that en and pure air were conducive to the well-being of the body”[306] And in the ale cited from an official publication the case of a well-known London physician, henever he enters a sick-rooht”
”An acquaintance of ours,” she added, ”passing a barrack one day, saw the s on the sunny side boarded up in a fashi+on peculiar to prisons and penitentiaries He said to a friend who accompanied hihbourhood' 'Oh,'
said he, 'it is not a penitentiary, it is a eneral principles commanded the hearty support of the better medical opinion, and to many medical n hospitals, afforded new and useful hints; while at the saeneral public, including town councillors, guardians, and benevolent persons It was in this way that her book did so much to iement in this country
[305] Above, p 342
[306] Speech on Lord Ebrington's Resolutions, May 11, 1858
[307] _Notes on Hospitals_, 1859, pp 100, 108
Upon the construction of eneral or attached to particular barracks--Miss Nightingale was consulted constantly and as a matter of course In 1859, it will be remembered, Mr Herbert became Secretary for War; and in 1860 Captain Galton was appointed teeneral of ”Fortifications”--a department which included works for barracks and hospitals She respected Captain Galton's abilities, and liked him personally very much He and Mr
Herbert took her advice upon all works within her province, and the plans of the new General Hospital at Woolwich in particular owed enuity She even drew up the heads of the specifications for it Even where she was not directly consulted or concerned, her influence and the standard she had set up in her book had an effect Medical officers and ht leave to be able to quote her approval of hospitals under their charge It would, as one navely wrote to her, improve their chances of promotion
A more direct result of the publication of _Notes on Hospitals_ was to bring in upon Miss Nightingale copious requests for advice from the comhout the country To all such requests she readily responded Writing ith her a iven any chance of translating ”Notes” into deeds, no trouble was too great for her She had decided views of her own, but in particular cases she often consulted other experts Dr Sutherland, one of the leading authorities in such matters, was, as we have seen, constantly with her To her kinse, Captain Galton, she frequently referred; and she soed Sir Robert Rawlinson professionally to prepare plans and specifications for her to submit to those who asked her advice He on his part often consulted her in regard to hospitals and infirmaries on which he had been called in to advise Her advice was sought both by those ere actually projecting new hospital buildings and by those ere leading crusades for the reconstruction of their local institutions A her papers there is a mass of correspondence, specifications, plans,to such matters Technical details are often relieved by touches of Miss Nightingale's humour Here are two examples from her letters to Captain Galton--(March 24, 1861): ”I understand that Baring[308] won't ventilate the Barracks in suh in winter
Why are the ust because they are too cold at Christ must be an army doctor” (June 20, 1861): ”Is the Architect's ideal the profile of a revolver pistol? If you look at the block plan in this point of view, it is very good But as he asks my opinion, it is that I would much rather be shot outside than in As Hospital principles are beginning to be well known, it would be quite enough to engrave this plan on the card of solicitation to stop all subscriptions No patient will ever get well there And as I don't approve of the principle of Lock Hospitals, I had o on” The correspondence about hospital plans ranges in place and scale froow, from which city she was asked to advise upon cement for the walls of the Infirmary wards, to Lisbon, where a new institution was to be built according to her ideas In 1859 the King of Portugal asked Miss Nightingale through the Prince Consort to advise and report upon the plans for a hospital which he desired to build in memory of his wife, the Princess Stephanie of Hohenzollern This affair occupied so two years, and caused her not a little impatience With Dr Sutherland's help, she went laboriously through the plans sub's architect on the assumption that the hospital was intended for adults It then appeared that what the King wanted was a Children's Hospital The Prince Consort, through Colonel Phipps, was deeply grieved at ”the waste of Miss Nightingale's ti an easier view, did not see that it mattered A hospital, constructed for adults, but intended for children, would, His Majesty pleasantly suggested, ”only give the children iven a lesson in the niceties of hospital construction The architect and Miss Nightingale set to work again on aestions armly approved, on the Prince Consort's behalf, by Sir James Clark, and Dom Pedro sent her a cordial letter of thanks
[308] Under-Secretary for War, when Mr Herbert was made a Peer
At home she took similar pains with plans for the Bucks County Infir, for the chairman of the Committee was her brother-in-law, Sir Harry Verney, and it was promptly decided (1860) to rebuild the Infirmary ”in accordance with the requireale's _Notes on Hospitals_” In another county hospital, that at Winchester, she took the more interest, because one of her father's properties (Embley) was in the county There is a specially voluely with Sir Willia over several years The old hospital was adhtingale took infinite pains in working up the case against this course She studied the report which Sir Robert Rawlinson, the sanitary engineer, had sent in; and she tabulated the statistics ofthem with those of well-appointed hospitals on healthy sites Thus ar to sinkup a ”pest-house, where a number of people are exposed to the risk of fatal illness froer, she asked, to emulate the evil fame of Scutari? Then she tackled the financial problem She compared the esti a new hospital on a better site She submitted plans and details of her estimate She promised the advice of Dr Sutherland in the choice of a new site ”I understand,” she wrote, ”that Lord Ashburton will give 1000 towards a new hospital, if built upon a new site; if not, nothing” As Lady Ashburton was one of her dearest friends, this condition was probably not unprompted On the same condition, she promised contributions from herself and her father She collected and sent in the opinions of eineers and medical officers--on the question She prodded friends possessing local influence: ”Would you please,” she wrote to Captain Galton (Feb 10, 1861), ”devote the first day of every week until further notice in driving nails into Jack Bonham Carter,[310] MP, about the Winchester Infirmary?” In the end she carried her point, and a new hospital was built by Mr butterfield on a higher and healthier site ”It is the greatest pleasure,” the architect wrote to her (Dec 1863), ”to try and work out the views of one who is ably and earnestly endeavouring toother institutions upon which she advised, in this (1860) or i years, were the Birkenhead Hospital, the Chorlton Union Infirmary, the Coventry Hospital, the Guildford (Surrey County) Hospital, the Leeds Infirmary, the Malta (Incurables) Hospital, the Putney Royal Hospital for Incurables, the North Staffordshi+re Infirn countries, and a collection of tracts upon Hospital Construction (1863) sent to her froium, show that the ”reformation” idespread In India also her book was found useful ”It arrived in the nick of ti