Returning from the Crimea, Florence Nightingale (1820-1910) was appalled by the conditions she found in many English civilian hospitals. Her belief that high mortality rates were preventable was seen as revolutionary. This 1859 collection of pieces on hospital design and sanitary conditions greatly contributed to improved medical care.
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"The following notes are by no means intended as a rule of thought by which nurses can teach themselves to nurse, still less as a manual to teach nurses to nurse. They are meant simply to give hints for thought to women who have personal charge of the health of others. ... Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge one ought to have--distinct from medical knowledge, which only a profession can have."--Preface.
Florence Nightingale is famous as the “lady with the lamp” in the Crimean War, 1854—56. There is a massive amount of literature on this work, but, as editor Lynn McDonald shows, it is often erroneous, and films and press reporting on it have been even less accurate. The Crimean War reports on Nightingale’s correspondence from the war hospitals and on the staggering amount of work she did post-war to ensure that the appalling death rate from disease (higher than that from bullets) did not recur. This volume contains much on Nightingale’s efforts to achieve real reforms. Her well-known, and relatively “sanitized”, evidence to the royal commission on the war is compared with her confidential, much franker, and very thorough Notes on the Health of the British Army, where the full horrors of disease and neglect are laid out, with the names of those responsible.
The following notes are by no means intended as a rule of thought by which nurses can teach themselves to nurse, still less as a manual to teach nurses to nurse. They are meant simply to give hints for thought to women who have personal charge of the health of others. Every woman, or at least almost every woman, in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid,—in other words, every woman is a nurse. Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge which every one ought to have—distinct from medical knowledge, which only a profession can have.If, then, every woman must at some time or other of her life, become a nurse, i.e., have charge of somebody's health, how immense and how valuable would be the produce of her united experience if every woman would think how to nurse.I do not pretend to teach her how, I ask her to teach herself, and for this purpose I venture to give her some hints.
Florence Nightingale began working on hospital reform even before she founded her famous school of nursing; hospitals were dangerous places for nurses as well as patients, and they urgently needed fundamental reform. She continued to work on safer hospital design, location, and materials to the end of her working life, advising on plans for children’s, general, military, and convalescent hospitals and workhouse infirmaries. Florence Nightingale and Hospital Reform, the final volume in the Collected Works of Florence Nightingale, includes her influential Notes on Hospitals, with its much-quoted musing on the need of a Hippocratic oath for hospitals—namely, that first they should do the sick no harm. Nightingale’s anonymous articles on hospital design are printed here also, as are later encyclopedia entries on hospitals. Correspondence with architects, engineers, doctors, philanthropists, local notables, and politicians is included. The results of these letters, some with detailed critiques of hospital plans, can be seen initially in the great British examples of the new “pavilion” design—at St. Thomas’, London (a civil hospital), at the Herbert Hospital (military), and later at many hospitals throughout the UK and internationally. Nightingale’s insistence on keeping good statistics to track rates of mortality and hospital stays, and on using them to compare hospitals, can be seen as good advice for today, given the new versions of “hospital-acquired infections” she combatted.