AC 8 Me HEALTH HEROES /^^mf ^^^^Hf^*^^ ^^^vnppiVii^ \ |R^^^rjS| ^^^HUJI^P^^ -4, ^^^1 Florence Nightingale METROPOLITAN LIFE INSURANCE COMPANY HOME OFFICE: NEW YORK Pdci^ Coast Hcadk Office: San Francisco Canadian Head Office: Ottawa Gbb'-G^ THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES GIFT OF DR. AND MRS. ELMER BELT HEALTH HEROES Florence Nightingale By Grace T. Hallock, coauthor of Growing Up, the Safe and Healthy Living series, and other health books and C. E. Turner, Professor Emeritus of Public Health, Massachusetts Insti' tute of Technology. Copyright, 1928, by Grace T. Hallock and C. E. Turner Grateful ac\nowledgment is made to the following publishers for permis-' sion to copy pictures: The Macmillan Company for por' trait of Florence Nightingale from The Life of Florence Jiightingale, Vol. I, by A. T. Cook, and for a scene from Florence from A Wan^ derer in Florence by E. V. Lucas; G. P. Putnam's Sons for pictures from A History of A[ursmg by Nut' TING and Dock; Underwood and Underwood for picture of Florence Nightingale as a young girl from A Modern World Setting for Amer- ican History by Jones and Sleman. (Edition of January 1948) jSf mjl' \ >"^/n Ti^p^nn^9irl1i>m VlmTrTr^r^rtifnll Florence Nightingale 1520-1910 LITTLE more than 100 years ago, a wealthy Englishman and his wife were traveling in Italy. Europe had then become safe for trav- elers because the wars of Napoleon had come to an end at last. In 1820, this couple, Mr. and Mrs. William Nightingale, and their little daughter. Par- THENOPE, were in the city of Florence. There, on May 12, another daughter was born to the Nightingales. She was named for her birthplace. Thirty-four years later the whole world was to hear the name of Florence Nightingale. METROPOLITAN LIFE INSURANCE COMPANY From the time she was 5 years old Florence had two homes in England. One was Lea Hurst, near the quaint village of Lea in Derbyshire. The other was Embley Park, near Romsey, on the edge of the New Forest. Both homes were surrounded with beautiful old trees and flower gardens. Florence loved flowers and birds and animals. She loved babies, too, and although there were none in her own family, she had a great many little cousins in whose teethings and baby illnesses she was greatly interested. The City of Florence, birthplace of Florence Nightingale ft '^ ^4^^^^ HEALTH HEROES— FLORENCE NIGHTINGALE Florence Nightingale at 8 years of age Education Florence was given a better education than was at that time thought suitable for young ladies. To be sure, she and her sister learned . all the usual female accomplish- Jk. «^ . ments. They were taught to use a \ 1 1 \ globe, to copy out ''elegant ab- T\ J stracts'' from various writers, to em- / / ^^ broider slippers and footstools, and \ ' tf'^"'^^^"""^ to do other fancy work. They |. studied music, grammar, composi- ^ tion and modern languages. Mr. Nightingale himself added to this learning by teaching his daughters Latin, Greek, mathematics and history. Florence was a good student and a quick one. By the time she was 17, she had read a truly formidable list of books in both modern and ancient languages. Her father had trained her to think clearly and to concentrate her mind on what she had to do. This training was to help her greatly in later years when quick, clear thinking meant the saving of lives. Florence was taught, as well, the usual manners and graces, which prepared her to take her place in the social world. She and her sister spent a season abroad and were then presented at court. Florence was not beautiful, but she possessed charm and distinction, and was a good, even a witty talker. 5 METROPOLITAN LIFE INSURANCE COMPANY Unhappiness Although Florence's life was full and busy, both in London and at the country houses of her family and friends, she was not happy. The occupations of a young lady of fashion could not satisfy her keen mind and un- bounded energy. The first record we have of her desire to become a nurse is found in a conversation which she had with the husband of Julia Ward Howe. In 1844, Dr. and Mrs. Howe were staying with the Nightingales at Embley. Florence said to Dr. Howe: "If I should determine to study nursing, and to devote my life to that profession, do you think it would be a dreadful thing?'' Dr. Howe replied: ""Not a dreadful thing at all. I think It would be a very good thing.'' But to Florence's parents and sister it did seem a dreadful thing. In every way possible they tried to turn Florence from her idea. But so definite was that idea that, shortly after her talk with Dr. Howe, the freedom to nurse sick people became Florence Nightingale's strongest desire. It is hard for us today to visualise what nursing was like in the first half of the nineteenth century. Many nurses were untrained, coarse, ignorant women. Some- times they were actually cruel to their patients. As a result, most hospitals in England, Scotland and Ireland were places of dirt and misery and needless suffering. Florence's family felt that they could not allow her to go into such conditions as these. She was bitterly disappointed when her mother re- fused to let her enter a hospital for training. To distract her mind, her family sent her abroad with friends. Wher- ever she went she visited hospitals and learned what she could of organisation and methods of nursing. HEALTH HEROES— FLORENCE NIGHTINGALE Happiness At this point in the life of Florence Nightingale came the first test of the quality of her determination. Persistence met opposition and conquered. Vain were the attempts of Florence's family to lure her from her purpose by offering the distractions of travel and the gayeties of social life. In 1851, she entered the Deaconess School at Kaiserwerth in Germany for a short term of training as a nurse. The life there was hard and bleak, but Florence Nightingale gloried in it. She wrote her mother: ''This is Life! I wish for no other earth, no other world but this.'' After this beginning there was no holding Florence Nightingale back. She had started toward the realizia- tion of her desire. It was to be a long, hard way, but her persistence was not to be denied. In 1853, Florence Nightingale took her first ''situa- tion." She became the Superintendent of an Establish- ment for Gentlewomen During Illness, in London. The fact that her patients were to be " gentlewomen" partly reconciled her family, but, even so, her mother did not understand her. With tears in her eyes, Mrs. Nightin- gale said:" We are ducks and have hatched a wild swan." The Kaiserwerth Training School, Germany METROPOLITAN LIFE INSURANCE COMPANY Map showing seat of war Outbreak of the Crimean War Florence Nightingale had been a year in her situation when, in 1854, the Crimean War broke out. Russia, with an eye on Constantinople, had seized some Turkish provinces on the Danube. This did not suit France and England, as it threatened their interests in the East. They joined Turkey in a war on Russia, and the battleground was the Crimea, a small peninsula thrust out into the Black Sea. There the fleets of the allied powers landed their troops, and there, in September, 1854, was fought the first great battle of the war, the battle of the Alma River. The allies were victorious and England went wild with joy. The Call But the rejoicing quickly changed to mourning. The number of the killed and wounded was very large and presently charges of neglect toward the sick and wounded in the military hospital at Scutari were published in a London newspaper. There was one woman in England who was ready, experienced in nursing, and anxious to HEALTH HEROES— FLORENCE NIGHTINGALE serve, who could come to England's help in this hour of desperate need. Fortunately there was one Englishman who knew it. Their letters to each other crossed in the mail. One letter was from Florence Nightingale offer- ing to go to the Crimea with a party of nurses. The other was from her friend, Sidney Herbert, the Secretary of War, asking her to go. Within five days from the time that each one had accepted the other's offer, Florence Nightingale, with a party of thirty-eight nurses, was on her way to Scutari, the place opposite Constantinople where the military hospitals were located. She left in a great burst of en- thusiasm. This Florence Nightingale, of whom most people had never heard five days before, had become a popular heroine. At Marseilles, Florence Nightingale laid in a large stock of supplies. She did this in spite of the fact that she had been assured at the War Office that nothing was needed for the comfort of the wounded soldiers. She and her nurses arrived at Scutari on November 4, 1854, ten days after the battle of Balaklava, and the day before the battle of Inkerman. They were given quarters in one tower of the Barrack Hospital, the chief hospital used in the Crimean War. The Military Hospitals Dark as the picture of conditions in the military hospitals had been painted in newspaper reports, the reality turned out to be darker still. Florence Nightin- gale had longed for a job equal to her ability and energy. Now she had one. Her tidy mind and her capable fingers had always itched to straighten out messes of any kind. Now, in the hospitals at Scutari, she found a huge muddle complicated by entangling red tape. In her own words. METROPOLITAN LIFE INSURANCE COMPANY she found ''The sanitary conditions of the hospitals of Scutari were inferior m point of crowding, ventilation, drainage, and cleanliness to any civil hospital, or to the poorest homes m the worst parts of the civil population of any large town that I have seen/' Ordinary comforts for the sick and wounded were lacking and necessary surgical and medical supplies were often not forthcoming. There were not enough beds, ''there were no vessels for Military Hospital, Scutari water, or utensils of any kind; no soap, no towels or cloths; no hospital clothes; no chairs, tables, benches, nor any other lamp or candlestick but a bottle.'' Often the wounded men were left lying in the uniforms they had worn on the battlefield. It was evident that there had been a complete break- down of medical arrangements at the seat of war. No one person could, or would, assume responsibility for this awful failure. It was not the time to exclaim, "What a mess!" nor to ask, "Whose fault is it?" That could come later. The only thing that mattered then was: Here is a job to be done. Florence Nightingale knew, of course, that her position was a delicate one. Women nurses in an 10 HEALTH HEROES— FLORENCE NIGHTINGALE army hospital were unheard of and the prejudices of both the medical and military authorities must be overcome. She made a good impression on most of the medical men from the beginning. She was an expert and they were quick to realise it. She obeyed rules and maintained a rigid discipline over her nurses. She never lost her temper, she never raised her voice, she was never over^ bearing, and so she won confidence. The Emergency The wounded from the battle of Balaklava began to arrive shortly after the party of nurses landed. In the Barrack hospital alone there were four miles of wounded soldiers laid not eighteen inches apart. The wounded lay up to the very door of the nurses' quarters. Florence Nightingale wrote home: ''Let no lady come out here who is not used to fatigue and privation,'' She herself was known to be on her feet for twenty hours at a time. Along with the permanent reform which Florence Nightingale made with patient persistence came this necessity for meeting emergencies. Cleanliness During the Crimean War, no one dreamed that in- fections after surgical operations, or after wounds re- ceived in battle, were caused by tiny living organisms. It was not until twenty years later that Lister introduced antiseptic methods in surgery by making practical use of the germ theory of infection taught by Pasteur. But Florence Nightingale did know that efficient nursing demands cleanliness. She set herself to supply this neces- sity. She found ''not a basin, nor a towel, nor a bit of soap, nor a broom," in the whole place. One of the first things she asked for was a supply of sacking and 200 hard scrub-brushes for washing the floors. II METROPOLITAN LIFE INSURANCE COMPANY Up to the time of her arrival the largest number of shirts washed in a month had been six. Florence Nightingale installed a laundry at once and employed in it the wives who had followed their soldier husbands to the front. Cooking After starting her clean-up campaign, the next thing that Florence Nightingale did was to install ''extra diet'' kitchens with the supplies she had laid in at Mar- seilles. Gone at last were the days when sick and almost famished men found themselves confronted with hunks of meat or bone or gristle from the thirteen copper kettles in which all the food for the hospital had been cooked. Now the meals were well prepared and served on time and there were delicate jellies and broths to be had when the doctors ordered them for their patients. Storekeeping Florence Nightingale set up a shop in a kitchen in her tower. She was the storekeeper, the doctors were the customers, and the patients the consumers. The medical officers found that they could get from Florence Nightingale necessary supplies which they could not possibly procure from the official purveyor of the army. But Miss Nightingale's stores could not last for- ever. As soon as matters were somewhat straightened out at the hospital, she set to work to unwind the red tape in which the official stores sent out from England were hopelessly entangled. Articles from the official stores were supplied to the hospitals by the Purveyor only on the requisition of a medical officer. The Pur- veyor would not unpack goods until they had been examined by the Board of Survey. This elaborate system led to delays which maddened Florence Nightingale. 12 HEALTH HEROES— FLORENCE NIGHTINGALE British private soldiers in the Crimean War Once she ordered a government consignment to be opened forcibly while the Purveyor stood by wringing his hands in fear of what the Board would say. Some- times she got the Board together herself and forced it to ''sit'' on supplies which were needed at once. She did not take the report of others as to what was in the store- house, but went foraging there herself. More often than not what she wanted was not there. Quantities of stores sent from England lay in the Turkish Custom House. Supplies for the hospitals, loaded under- neath the cargoes of shot and shell, were sometimes car- ried to and fro three times over the Black Sea before being landed at Scutari. Florence Nightingale saw that the whole system was at fault, and, six months after her arrival, she succeeded in having established, at Scutari, a storehouse for the reception and distribution of supplies. 13 METROPOLITAN LIFE INSURANCE COMPANY The Ministering Angel The military surgeons, the orderlies, her own nurses, the Purveyor, saw in Florence Nightingale the ''im- pelling power of a brain and a wilP' set to bring order out of the chaos in the military hospitals. But to the sick and wounded and to the public at home, she was known as the Angel of the Crimea. At night when the medical officers had gone to bed and darkness and silence had settled down on those miles of prostrate sick, she might be seen, alone with a lamp in her hand, making her solitary rounds. One boy wrote home in a letter which became famous : What a comfort it was to see her pass, even. She would speak to one and nod and smile to as many more ; but she could not do it all, you know. We lay there by hundreds, but we could kiss her shadow as it fell, and lay our heads on the pillow again content. The men adored her. They saluted her as she passed down the wounded ranks. ''Before she came,'' said one soldier, "there was cussin' and s wearing but after that it was 'oly as a church.'' Another, who had lost a leg at the Alma River said, "If the Queen came for to die, they ought to make her Queen, and I think they would." They wrote home for her. They saved their money for her. They went through painful operations without a murmur for her. She called them "her children," and the dead to her became "the heroic dead." With all her other duties, Florence Nightingale carried on a huge correspondence. Late at night when the hospital was in darkness, she sat at her small unpainted table and wrote the dying messages of soldiers to their relatives, long reports to ministers at home and to military and medical officials at the seat of war. She filled page after page with recommendations, suggestions, criticisms, statistics, and storekeeping accounts. 14 HEALTH HEROES— FLORENCE NIGHTINGALE Results Six months after Florence Nightingale's arrival, the results of her activity were clearly apparent. Order and cleanliness reigned in the wards. The hospitals were better supplied. Sanitary improvements, so important that Florence Nightingale said they had saved the British Army, had been carried out. Most remarkable of all, the death rate among the cases treated had fallen progressively from 420 a thousand in February, 1855, to twentytwo a thousand in June, 1855. The Lady of the Lamp 15 METROPOLITAN LIFE INSURANCE COMPANY In the Crimea Not content with reforms at the hospital base, Florence Nightingale now set out to inspect hospitals at the seat of war. She made her first visit to the Crimea in May 1855. Shortly after her arrival, she came down with what was called Crimean fever. Even then, although she could not walk, she could write, and write she did, until she became delirious. When, after many weeks, she was well enough to be moved, she refused to return to England. ''I am ready to stand out the war with any man,'' she said. On September 8, 1855, Sebastopol fell. From this date until the end of the war, Florence Nightingale divided her time between Scutari and Crimea. In the Crimea the work was very hard. She spent whole days in the saddle, or was driven in a baggage cart over bleak and rocky roads. She stood for hours in the heavily falling snow. Often she did not reach her hut until late at night after walking for miles through perilous ravines. At last the war came to an end. Peace was signed in Paris on March 30, 1856. Four months later Florence Nightingale sailed for England. At Scutari 16 HEALTH HEROES— FLORENCE NIGHTINGALE Florence Nightingale The Heroine During Florence Nightingale's illness in the Crimea, all England had held its breath. When the bells were ringing ''Victory!'' after the fall of Sebastopol, the name of Florence Nightingale was on every tongue. Now that she was coming home, a rousing welcome was planned for her. She was to be transported on a man-of-war. Three military bands were to meet her at the station and play her home whenever she might arrive, by day or by night. Florence Nightingale refused the man-of-war. On August 7, 1856, a lady dressed in black entered the back door at Lea Hurst. The old butler hastened to put her out. She lifted her veil; it was Miss Florence. The heroine had not chosen to publish her time of arrival. 17 METROPOLITAN LIFE INSURANCE COMPANY After the War Florence Nightingale lived for more than half a century after her return from the Crimea and m all that time she practised the most rigid seclusion in order to save strength for her work. The upper rooms of her house in South Street, London, became the center of a network of reform which spread over the world. In the heyday of her usefulness she, a semi-invalid, lay on her couch in her upper room, writing, writing, writing. Below in the sitting-room, great statesmen, famous generals, foreign royalties begged for audiences. For many years, the newly appointed Viceroy to India paid her a visit before leaving for his post. She had the admiration of Queen Victoria, who had said when she met Miss Nightingale, ''Such a head! I wish we had her at the War Office.'' On her return from the Crimea, her friends begged her to rest. Rest! How could she? She could never forget the heroic dead. She could never forget that many of her ''children'' were lying in their forgotten graves from causes which might have been prevented. Her experience in the Crimea, when it was happening, had been her job. After it was over, it had become an example. She said: "The sanitary history of the Crimean campaign . . . is a complete example — history does not afford its equal — of an army, after a great disaster arising from neglects, having been brought into the highest state of health and efficiency." Now was the time to drive home the lesson of this example. With the help of Sidney Herbert, she set out to reform the Army Medical Service. She found that even in the army at home the death rate was nearly double that of civil life. "You might as well take i,ioo men every year out upon Salisbury Plain and shoot them," she said grimly. HEALTH HEROES— FLORENCE NIGHTINGALE Sanitary Reform in the Army She met stubborn opposition, but in the end she forced the Minister of State for War to appoint a com- mission to report upon the health of the army. She her- self worked day and night to help the commission. When the report was finished the next task was to have its recommendations put into effect. In the end this proved to be easy, as her friend, Sidney Herbert, became Secretary of State for War. The army barracks were re- modeled; the responsibilities and duties of Florence Nightingale's old foe, the Purveyor, were accurately defined. An Army Medical School was established, and the Army Medical Department was reorganised on the principle that it is as much a part of the duty of the authorities to take care of the well soldier as it is to take care of the sick soldier. By 1861, as a direct result of these reforms, the death rate in the army at home had decreased by one-half since the days of the Crimea. Balmoral Castle 19 METROPOLITAN LIFE INSURANCE COMPANY Reorganization of Army Statistics Another valuable service to the cause of army reform was the emphasis which Florence Nightingale laid on the reorgani2;ation of army statistics. She herself, who had a passion for statistics, had been exasperated time and again with the discrepancies in official statistical returns. With great skill she pointed the way to a better system. She was greatly helped and encouraged in her reform of army statistics by Dr. John Sutherland, one of the lead- ing sanitarians of his day; by Dr. William Farr, as deeply interested in statistics as she; and by Dr. T. Graham Balfour, who was appointed head of the sta- tistical branch of the Army Medical Department. When the recommendations of the commission on army reform were carried out, the British Army statistics became the best and the most useful then available in Europe. Sanitary Reform in India Florence Nightingale was not content with reforms directed toward the health of the army at home. She reached out to the troops in India, and her main work for many years has been described as ''Health Missionary for India.'' After an investigation into the existing sanitary conditions of the Indian army, a commission, appointed at her suggestion and working with her assistance, did for the troops in India what sanitary reform had done for the army at home. Her interests in India spread from the troops to the natives. She worked in season and out of season for sanitary improvements in native living conditions and for irrigation projects which would free the Indian farmers from their ever-present fear of famine. 20 HEALTH HEROES— FLORENCE NIGHTINGALE 7s[ursing School of St. Thomas Hospital The Nurses Training School While Florence Nightingale was still in the Crimea, a movement was started to mark in some public manner the nation's appreciation of her services. It was decided to raise a fund for the establishment of a training school for nurses of which Florence Nightingale would be the head. This school, which was connected with St. Thomas's Hospital in London, was opened on June 24, i860, with fifteen probationers. On this modest scale there was launched a scheme which was destined to found the modern art and practice of trained nursing. Florence Nightingale's own delicacy of observation and fine nursing technique were indelibly impressed on the first nurses' training school. In her book, ?{otes on ?v[ursing, are found the precepts which she insisted must be translated into action. The welfare and comfort of the patient must come first always. There must be plenty of sunlight, proper ventilation and scrupulous cleanliness in the sick room. The Nightingale Training School created a new model for nurses and the Js[otes on 7