The Great Leader Series No. 2 – Florence Nightingale

Florence Nightingale, the Lady with the Lamp, has the image of a genteel lady who travelled to the Crimea and quietly waved a magic wand to improve the health care of the British army fighting on the Crimean peninsula.

Nothing could be further from the truth. Florence Nightingale was a formidable woman from a wealthy background who fought the male dominated establishment and the Church tooth and nail to bring order and hygiene into a chaotic, disease ridden organization.

Florence was born in May 1820, in the city of the same name during an extended wedding trip by her parents. She grew up mainly in Hampshire but the family spent their summers in Derbyshire. Her parents were unable to find a governess, for Florence and her sister, who could satisfy their father’s intellectual requirements; so he taught them Greek, Latin, German, French, history, grammar, composition and philosophy with a governess purely for music and art. Thus Florence was unusually well educated.

Florence decided she wanted to be a nurse in 1844 after four “visitations from God” and worked as a superintendent of the Hospital for Invalid Gentlewomen in Harley Street.

Florence wrote to Sidney Herbert, the reformer, about travelling to Turkey to nurse when he approached her. Their letters crossed in the post. His request decided her. She would go. This was her opportunity to show the value of female nurses in military hospitals. She was assured that there would be wonderful facilities and plenty of supplies. Imagine the shock to both Florence and her nurses on arrival……there was nothing.
Florence had no desire to take a large group of nurses. She felt that the discipline and care of her nurses would be a difficult task and the larger the group the larger the problem. She also had no desire to take a group of nuns as she felt that they would try to convert their patients to Catholicism which she felt was unacceptable as her motivation was to save men’s lives not their souls.

So Florence travelled to Scutari with a group of 38 women. It is said she only nursed for six weeks and spent the rest of her time in administration. Contending with the appalling state of the hospitals and lack of equipment took up all of her time. There was a shortage of beds, cutlery, food, stump pillows, shirts and uniforms. All of these were provided by Miss Nightingale at one time or another.

There was great opposition, from both the army and the medics, to female nurses.

Her first challenge came when, after the Battle of Inkerman, with only half an hour’s notice, 1,763 wounded soldiers, and 96 wounded officers arrived. Florence and her nurses had to stuff, sew up and lay down mattresses on the floor as there were no beds. Can you imagine the effort Florence must have put in directing locals and mobile patients to help her nurses, all the while keeping everyone motivated? All the men had to be washed and their wounds dressed. This they did in eight hours! There were four miles of beds not more than eighteen inches apart. These poor men had not washed for two months before they arrived and most of them were crawling with lice. Florence had neither bowl, soap nor broom to clean with and she ordered 300 scrubbing brushes.

Florence soon realised that the destruction of the British Army was due to illness rather than battle losses. One of the best surgeons at Balaclava, Dr Blake, treated 3025 cases of sickness and only 564 for wounds. Cholera was rampant. After the war it was realised that soldiers stood more chance of surviving in the divisional campsites despite the appalling conditions, than they did in the hospital at Scutari. The journey to the hospital consisted of a trip to the harbour strapped to a donkey, being transferred to boats and then rowed to the ships, placed on the deck or in the stifling hold for an eight day journey. They were then rowed ashore and strapped to stretchers for the final journey to the hospital. It’s amazing that anyone survived.

After the Battle of Inkerman the soldiers suffered many privations as a hurricane sank the ships in the harbour, which held winter clothing, medical supplies and ammunition. What food there was had to be eaten raw as fuel was non existent. Their tents and clothes were in tatters. The hospitals were in an even worse state. The army had ordered the purveyors to exercise thrift at all times and these orders were never changed.

The strict hospital administration ground to a halt and records were no longer kept. This affected the purveyors’ department and resulted in poor motivation for her nurses. Florence railed against this, sending many letters back to her supporters in London, many of which were ignored. She decided to persevere using her own monies and she continued to care for the sick. The motivation and morale of the nurses was greatly enhanced.

Another challenge was the organisation of the British government’s handling of logistics. Florence became the first army statistician and dealt with purveyors, many of whom were Turkish. The Establishment in London did not like requests from women, let alone orders. Sidney Herbert was often defeated in Parliament when he tried to help Florence with reforms. There were many arguments between them, and meanwhile, men were dying. Requisitions were not filled in full and men were arriving from the battlefield naked. In October 1855 she did receive 10,000 flannel shirts but these disappeared when the men were discharged from the hospital, as they had nothing else to wear, requests for new uniforms having been disregarded!

But throughout all these she fought the medics and army to be able to manage and motivate her nurses. She worked them hard and, on occasion they rebelled.

By 1855 a group of nuns had arrived, and were working, in the hospital in the Koulali in the Crimea. Although they were disciplined and skilful nurses they fell foul of the army officers as wine, invalid food and clothing were dispensed where the nuns thought necessary but they were deemed to be being extravagant. The Principal Medical Officer finally insisted that these items were only given out on the express orders of a medical officer. The nurses’ leader, Mother Bridgeman, refused and sent her group to the hospital in Balaclava and ordered her four nuns still in Scutari to join her! Balaclava became the stronghold of Florence’s enemies. Her appointment as “Superintendent of the Nursing Establishment of the English General Hospital in Turkey” was questioned by Dr Hall and David Fitzgerald, the Purveyor, led a group of military officers in their final move against her, saying that Balaclava was in the Crimea and, therefore, not under Florence’s jurisdiction…. and Florence’s ally Lord Raglan had died. Florence felt isolated and betrayed.

Later, in November of that year, Dr Hall came under fire himself. Trial by the press and comments by ministers saw him move on to India, despite Florence’s support of his medical skills. He was sorely missed despite his hostility, he had good doctoring skills. After his departure Florence continued to pay for extras such as eggs, butter, jelly and ale, and the building of an Extra Diet kitchen, out her own pocket and with financial support of a Mrs Shaw Stewart. The opposition had lost its leader allowing Florence to move her “battle” on. But the Establishment and the Army continued in their condemnation of her. They did not like her having any authority in their “men’s world”, but they could not deny her skills and those of her nurses

Florence led her nurses well, supporting them, but also being tough and sending home those who succumbed to the “evils” of alcohol. She was strong in her use of the rules, not allowing any wastage and requiring that her nurses’ uniforms were either returned or paid for when they were dismissed.

There was an insistence that hygiene rules be followed as strictly as the circumstances allowed. During the first winter in Scutari there was a death rate of 42% amongst patients. This had fallen to 3% by the end of the conflict!! At one time a dead horse had to be removed from the water supply.
 
Her determination to get the job done and her abilities to organise and support her nurses along with her refusal to be ignored brought great changes both during and after the war in the Crimea. She set the standards of hygiene, cleanliness and organization that are the hall marks of good nursing practice today.

Florence returned to England a national heroine and was presented with a brooch by Queen Victoria; the first woman ever to be so honoured. She continued to fight for improved nursing with the queen’s support.

After the Crimean War Florence was taken ill, possibly post traumatic stress disorder, and never appeared in public although she continued to work.

In November 1907 she became the first female to have the Order of merit bestowed on her. It was presented by King Edward VII.

She died on 13 August 1910.

Her ability to get the job done, in terrible circumstances, while facing strong opposition, shows the leadership values of hard work and following your vision.

Bibliography:

Florence Nightingale: letters from the Crimea Florence Nightingale

Florence Nightingale: reputation & power  F B Smith

Ever yours, Florence Nightingale.
Selected Letters by Florence Nightingale

Acknowledgements:

My thanks go the staff at the Florence Nightingale Museum, in particular Jenny Mollergren. A link to their website is below.

Date : 15-11-2005