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In his eyes, an overview of the 1800s is incomplete
without significant discussion of Nightingale.
"Her ideas were not original, but her genius lay
in codifying things about hospitals and how they should
and should not be run," Martensen said. "She
paid a lot of attention to hospital organization in
her [book] Notes on Hospitals, going into elaborate
detail on how hospitals needed to be organized in terms
of their physical spaces, how they needed to be sited
and so forth.
"What she added to that text [of knowledge] and
reinforced later was the importance of nurse training,"
Martensen said. And "her vision was always one
that had as many moral and social ideas as it did medical
ideas."
In the years before she worked in the Scutari British
Army Barracks hospital in Turkey, Nightingale traveled
extensively across Europe, visiting hospitals where
she would study and absorb the medical practices of
doctors, nurses and religious charity organizations
in England and other countries.
For 13 years, Nightingale visited every hospital in
London and Paris, as well as military and civilian hospitals
in Germany, France, Greece and Italy, according to a
1950 biography of Nightingale by Cecil Woodham-Smith.
Her love of mathematics and statistics fueled her relentless
analysis of numbers and rates that would yield trends
and causal factors. The impact of her use of graphics
to chart the deaths of soldiers in army barracks cannot
be understated, said Nightingale scholar Deva Marie-Beck,
Ph.D., RN. Nightingale knew the "old coots in parliament
will understand pretty pictures. They won't read the
reports."
Nightingale's mathematical work was so impressive that
she was granted membership in the Statistical Society
of London in 1858.
In Notes on Hospitals, Nightingale used her numbers
to rail against patient overcrowding, poor nutrition
for patients and the spread of fungus and vermin. She
used comparative data between English and the more advanced
practices of some French hospitals to differentiate
mortality rates, according to Lois Monteiro, a Nightingale
researcher and professor of community health and sociology
at Brown University in Providence, R.I.
She also saw the numerical shortcomings of hospital
administrations. Until 1859, hospitals did not have
uniform systems for diagnosing or even naming diseases,
and kept no data on ages, addresses or gender with illnesses
and injuries. After Nightingale drafted model hospital
statistical forms, 13 London-area hospitals adopted
them, according to Woodham-Smith.
For Nightingale, architectural problems in hospitals
were another hot-button issue. She recommended a new
"pavilion" design, gleaned from her travels
abroad and her military experience. In this design,
patients would be segregated into smaller rooms instead
of lined side by side in cavernous, open areas. Nightingale
wrote that patient areas should be well-lit and have
proper ventilation to keep away odors and noise from
the operating rooms, kitchens and cleaning operations.
"One contribution she made to hospital design
that isn't often talked about … is placing the
nursing station so the nurse was in sight of all the
patients," Martensen said.
These were all theories and ideas she was able to put
into practice when she consulted in the 1860 construction
of a new St. Thomas' Hospital in London.
Nightingale had the ear of so many hospital administrators
because she was among the few people who had any breadth
of experience in international health practices. Fluency
in five languages allowed her to read hospital reports
and policy manuals in their native languages. She saw
firsthand the burgeoning movements of nonsecular training
of lay women to work in hospitals, rather than relying
solely on devoted nuns and sisters, according to Marie-Beck.
Nightingale discovered the unique sanitation and health
problems of places like India, and she spent much of
her later life working to cure these problems.
"She was able to look at health at the community
level, the regional level, the national level and the
global level" from the earliest moments of her
career, said Marie-Beck, co-author of a forthcoming
book on Nightingale.
At the root of Nightingale's drive to change health
care-which she accomplished as a near invalid confined
to her home because of a long-term, acute illness-was
her well-documented pursuit of raising the professional
standards of nursing.
Her Crimean War experience helped prove to a doubting
public that women could be useful near the frontlines
of a battle. She was now intent on making nursing on
the home front a valuable addition to her ideal model,
according to historians.
In 1860, through money raised in a foundation named
in her honor, Nightin-gale established a training school
at St. Thomas' Hospital. Even with the money and her
popularity, several social obstacles stood in her way.
Catholic charities, the predominant provider of care
and assistance to Europe's poor, were almost nonexistent
in Protestant England, according to Marie-Beck, as were
career options for poor women.
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