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| The
inevitability of rampant deaths in medical institutions
was a soberly accepted fact in the 1840s and 1850s.
This disturbing reality began to change only after
it was smothered under a mountain of facts, data
and new ideas from hygienic and sanitation activists—most
notably Florence Nightingale. |
Shining Light (First
part of this two-part series)
The most influential period of Florence Nightingale's
career often has been her most overlooked. The Lady
with the Lamp, who worked at correcting the horrific
conditions at army hospitals near the front of the Crimean
War, devoted her post-war years bringing changes to
health care at home in England and abroad-raising the
standards for both hospitals and for nursing.
Hospitals in Victorian England were no place for patients.
Especially for those who were hoping to get well.
Operated strictly for indigent patients (the well-to-do
received home-based care), hospitals were overcrowded
and filthy lairs of disease and neglect where one in
seven patients died. It was even worse for the larger
metropolitan facilities in London, where statistics
showed those with 300-plus beds were suffering one death
per 2.4 patients-despite the prestige of employing the
most well-respected medical staffs and physicians in
the country, said medical historian Robert Martensen,
MD, Ph.D.
"The term itself for people getting sick in hospitals
was called 'hospitalism'-this notion that the hospital,
the building itself, would make one ill," said
Martensen, chair of humanities and ethics in medicine
at Tulane University School of Public Health and Tropical
Medicine in New Orleans.
The inevitability of rampant deaths in medical institutions
was a soberly accepted fact in the 1840s and 1850s.
This disturbing reality began to change only after it
was smothered under a mountain of facts, data and new
ideas from hygienic and sanitation activists-most notably
Florence Nightingale.
An 1857 Royal Commission on sanitation, studying the
high number of Crimean War deaths between 1854 and 1856,
came to the conclusion that nearly 16,000 soldiers died
needlessly from organizational mismanagement, neglect
and unsanitary conditions at army hospitals. According
to historians, the prime evidence was a ground-breaking
report written by Nightingale herself, one that was
filled with comparative numbers, statistical analysis
and carefully drawn pie charts that rarely had been
seen in a public policy document. "Our soldiers
enlist to death in the barracks," Nightingale concluded
in her nearly 1,000-page report.
Scholars say her largely uncredited contribution to
that commission (women could not serve on such public
boards) was the starting point for foundational changes
in military medical sanitation, training and data collection.
Her ideas also were adopted for civilian hospitals,
according to researchers, and helped foment a surge
in public health standards in England and across the
globe, especially for the poor.
Nightingale returned from the Crimean War a hero, the
"Lady with the Lamp," who had saved and nurtured
British soldiers near the frontlines of an unpopular
war. The name was coined because she carried a lamp
as she checked on sick soldiers during the night.
Had she done nothing else, her picture still would
have adorned British currency a century later. But Nightingale's
incredible career had only begun, and her greatest accomplishments
were yet to be established.
Each fall, incoming students at Tulane Medical School
arrive in Martensen's history of surgery class to learn
from the deep repository of techniques, theories and
practices collected during the past 500 years. Martensen,
who has degrees from Harvard, Dartmouth and the University
of California, San Francisco, takes them on a tour through
the 16th century natural philosophists to the 19th century
stewards who applied the scientific model to medicine.
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