Florence Nightingale’s Dark Decade

512HMzMnfSLOn the 12th of May 1820, Florence Nightingale was born in Florence, Tuscany, the city she owes her name to. She was a national heroine in her lifetime already, elevated to near sainthood by some and bitterly criticised by others. Much of this is due to the fact that this complex and dedicated woman had often been seen as an enigma. Several editions of her letters have been published in volumes, yet there still is no all-inclusive modern biography of her, mainly because of the enormous amount of material documenting her life: the Nightingale Papers in the British Library are second only to the Gladstone collection. Nightingale’s reputation has been consistently questioned by 20th century writers, leading to a reevaluation of the very construction of icons and social myths in history.

The most shocking episode in Nightingale’s life occurred in Constantinople in 1954-5: Florence arrived in Constantinople on 4 November 1854, together with a band of 38 other nurses. Although her stated assignment was to care for soldiers in Scutari Barrack Hospital, some 300 miles from the Crimea, her arrival was greeted with suspicion by the medical authorities as nobody had informed them of her visit. Florence’s quarters were overrun by rats and the corpse of a Russian officer lay rotting on the floor. However, within a few days of her arrival hundreds of casualties from the Battle of Inkerman arrived and Florence and her nurses found themselves working around the clock. Determined to take charge of the situation, Florence wrote letters to Sidney Herbert, naming those individuals she believed were incompetent. She also took more direct action and dismissed a band of Irish nuns who had been drafted in to help her. Conditions in the hospital were appalling. Thousands of sick and wounded soldiers lay on mattresses along four miles of corridors, with barely enough room for the doctors and nurses to walk between them. In her efforts to improve the situation, and being a proponent of the then dominant ‘miasma theory’ of disease’, Florence insisted on the utmost cleanliness. Despite these efforts, death rates at the Scutari Hospital remained obstinately higher than in the tented field hospitals at the front. 51tbDBphhaLBetween November 1854 and March 1855, 4,077 soldiers died at the Scutari Hospital, while in one regiment, of the 300 men who were admitted, not one came out alive! In her hospital, a soldier was ten times more likely to die from cholera, typhoid or dysentery than from a battle wound. Of course, another reason for the poorer survival rates at the Scutari Hospital was that the wounded had had to be transported 300 miles by sea from the front. In an effort to address this situation, and following an emergency debate and the defeat of the standing British government, the new Prime Minister, Lord Palmerston, sent out a Special Commission of public health experts to examine the site. What they discovered shocked the nation and Florence. The hospital, that had originally been built by the Turks as a barracks, had been built over a cesspit. Thus the patients had been unwittingly drinking their own sewage, accounting, at least in part, for the incidence of mortality. Having made this discovery, the commissioners were able to implement procedures to deal with the problems of vermin, overcrowding and ventilation. (BBC, h2g2).

In Florence Nightingale: Avenging Angel (2000), Hugh Small brought new explanations to the table, particularly about the major period in Nightingale’s life following Scutari – her decade of self-confinement to bed starting in 1857. By analysing previously unpublished primary sources, Small held that Nightingale suffered a “breakdown” when she retrospectively found herself responsible for over fifteen thousand infectious disease deaths in military hospitals during the Crimean War. At her worst, she reportedly suffered spinal pain, muscle weakness, headaches, nausea, breathlessness, palpitations and mood changes most of which were indicative of a stress-related nervous breakdown, rather than a physiological condition. Small claimed that Nightingale’s emotional shock was intensified by feelings of guilt associated with her participation in attempts to disguise the “truth.” However, at the time, Nightingale had genuinely believed that the Crimea hospital deaths were mainly due to late hospitalisation, as well as the miasma theory of disease causation, according to which noxious gases from poor ventilation and overcrowding were the real culprit behind the overwhelming death rates.

71792FY1fCL._SL1360_“Before the Royal Commission released its official report, Nightingale put together confidential testimony that included detailed comparative statistics for all the hospitals in the Crimea and documented the deadly conditions at Scutari, attributable to its lack of cleanliness. Neither this evidence nor Nightingale’s conclusions were published as part of the public report of the Royal Commission, although a year later she sent copies of her report to selected friends at her own expense. Herbert refused to join Nightingale’s crusade to place blame and instead focused the final report of the commission on efforts to reduce mortality by better construction. At this point, in 1857, Nightingale took to her bed for over ten years.” (Julie Fairman, review of Florence Nightingale: Avenging Angel by Hugh Small, in Isis, Vol. 92, No. 2, Jun., 2001). Bitter regret, shame, feelings of helplessness and stress sent Nightingale over the edge. Moreover, her state was worsened by her analysis of newly available statistical data which also showed that her hospital, Scutari, had higher death rates than any other military hospital in the Crimea, including the primitive front line hospitals which she had implored Lord Raglan, commander of the British forces, to close down due to inadequacy. While her achievements and dedication to nursing has been recognised worldwide, this dark period in Florence Nightingale’s life must have haunted her to the end of her days, at the age of 90.