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Nurse’s Notes

Florence Nightingale

Florence Nightingale: Avenging Angel

by Hugh Small
St. Martin’s Press, NY, NY, 1998.

Florence Nightingale has gone down in history as much a saint as any man or woman outside the Catholic Church. She is remembered as having been something of a savior to thousands of soldier patients who passed through her hospital (1856-57) at Scutari during the Crimean War.

Henry Wadsworth Longfellow immortalized her in a poem as the “lady with a lamp.”

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering of gloom
And flit from room to room.

And slow, as in a dream of bliss,
The speechless sufferer turns to kiss
Her shadow, as it falls
Upon the darkening walls.

– excerpt from Santa Filomena

After the Crimean conflict, she returned to England and was bedridden for over ten years. Physicians wanted to blame her ills on brucellosis, psychologists on the shock and guilt which piled up over the many thousands who died under her keeping. She gradually rose again to become a crusader for better hospitals and sanitation everywhere.

Avenging Angel spends most of its pages on the political aftermath of the Crimean War and Florence’s part in it. The early part of the book briefly covers her first 30+ years in a wealthy Victorian family in which a woman’s place was at home either as a wife or a spinster. Still, Florence was well-educated thanks to her father and her own studies and travels. All the while, she yearned to be of service.

Miss Nightingale most wanted to work in a hospital setting and aid her fellows. But, that path was largely limited to Catholic nuns. There was little place for Anglican women as nurses. Inevitably, she managed to take four months of training in Germany and was later named as superintendent to the Institute for the Care of Sick Gentlewomen in London. Although Florence only held that position for little more than a year, she was deemed an expert by politicians of the day. To such an extent that Miss Nightingale was named to head the main British hospital taking casualties during the war in Crimea.

Florence did the best she could – or knew to do – during her tenure, but gradually realized how inadequate were her works, how deadly was her hospital, how ignorant was medicine practiced. The equivalent of a whole army (14,000 soldiers) which died before her, she came to believe, due to the lack of elementary sanitation. Her hospital was a three-story, 700 square-foot building requisitioned for medical purposes. It soon was packed with more than a thousand patients in sorry conditions.

Ever so slowly, Nurse Nightingale realized that she “had not been running a hospital. She had been running a death camp.” 10,000 died during the first winter, only 500 the second. But, the Angel of Death still held sway at the Scutari hospital. Mortality for amputations was over 80 percent. The head physician instructed surgeons not to use anesthetics during such operations which were done in full view of other patients until Florence screened off the affairs. Still, the poor wretches’ “lusty bawls,” which Dr. Hall believed more useful than chloroform, must have been terrifying to their fellow patients. Nightingale tried to get surgeons to ignore Hall’s order.

Fortunately, the War and Florence’s part in it ended in 1857 and Nightingale returned to Britain. 2600 Englishmen had died in battle, 16,000 by illness, and 1800 by wounds. Pestilence rather than bullets was by far the greater adversary. With the help of medical investigation after the fact, Florence and associates were able to determine that poor hygiene was the gravest threat of all in the Crimean War. Overwork with inadequate food, clothing, and shelter had killed almost a whole army.

“Troops who were billeted indoors in comfort died in great numbers while those who shivered beneath the stars usually lived.”

For the rest of her days, Florence Nightingale crusaded for better hygiene rather than for improvements in nursing, which she deemed relatively irrelevant. She wrote a number of books and many thousands of letters – possible the greatest letter-writer second only to Charles Dickens – to bring forth the true state of doctors, hospitals and hospital nursing. She battled the system at most every turn and summarily deserted medicine.

This book is much more about war and logistics and politics than about Florence, The Avenging Angel. But it apparently covers much information which has been overlooked, hidden, or shunted aside in most studies of Nightingale’s life. It leads this reviewer to plan on reading her Notes on Nursing.

In any case, Avenging Angel is a valuable text and gives insights into Victorian England, the Crimean War, and medical politics. Florence’s conclusion even now would remain that, “True nursing should be defined as ‘the proper use of fresh air, light, warmth cleanliness, quiet, and the proper selection and administration of diet - all at the least expense of vital power of the patient….”

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