Progress in the Mid-19th Century: Nightingale, Chadwick, Snow and Simpson » Florence Nightingale at Scutari

Why Nightingale went to Scutari

In 1854 Britain, France and the Ottoman Empire were at war with Russia in the Crimean War (1854-56). Thousands of British soldiers were sent to the Crimea, a peninsula on the Black Sea. The sick and wounded were shipped across the sea to Scutari, near Constantinople (now Istanbul), where the army used a huge former barracks as its main hospital.

In the autumn of 1854 a journalist, William Howard Russell, wrote reports for The Times describing how badly the soldiers were looked after. The public was shocked. The Secretary at War, Sidney Herbert, knew Florence Nightingale and asked her to take a team of nurses out to Scutari.

Nightingale was born in 1820 into a wealthy family. Her family did not want her to work, but she was determined to become a nurse. She spent a short time at a hospital run by a religious community in Kaiserswerth, Germany, and later ran a small nursing home for sick women in London. In late 1854 she set out with 38 nurses and reached Scutari in early November.

Key terms:

• Crimean War: a war (1854-56) in which Britain and France fought Russia.
• Scutari: the town near Constantinople where the British army's main hospital was based.
• Sanitary Commission: a group of experts sent by the British government in 1855 to improve cleanliness and drainage.
• Death rate: the share of patients who die, such as 42 out of every 100.

Conditions when she arrived

The Barrack Hospital at Scutari was crowded and filthy. Each new wave of wounded men from battles such as Inkerman made it worse. The main problems were:

Far more soldiers died of disease than of wounds. Typhus, typhoid, cholera and dysentery spread quickly among weak men packed together in dirty wards. Army doctors were overworked and at first did not welcome the nurses, so Nightingale waited to be asked for help before she began.

What Nightingale and her nurses changed

Once the doctors accepted her help, Nightingale made a series of practical changes:

• Cleaning: the nurses scrubbed floors and walls and washed patients. Clean bedding and clothes were issued.
• Supplies: she bought items the army did not provide, such as shirts, bandages, utensils and food, using money raised by the public.
• Food and care: she set up kitchens so patients got hot, proper meals, and her nurses looked after the most seriously ill.
• Order and comfort: she set up a laundry, helped soldiers write letters home and kept the wards organised. She made night rounds with a lamp, which led to her nickname 'the Lady with the Lamp'.

Her efforts did not stop the deaths at first. In February 1855 about 42 out of every 100 patients in the Barrack Hospital died. Deaths stayed high because the building itself, with its blocked sewers and dirty water, was spreading disease.

The Sanitary Commission and the results

In March 1855 the Sanitary Commission arrived at the government's order. It flushed out the sewers, cleared away rotting waste (including a dead animal polluting the water supply), improved ventilation and made the water safe. By June 1855 the death rate had fallen to about 2 per cent. Nightingale later accepted that poor sanitation, not only poor care, had caused so many deaths.

So the improvement came from two things together: Nightingale's nursing and organisation, and the Commission's work on drains and water. Historians still argue about how much credit each deserves.

Change and continuity

What changed: Scutari showed that cleanliness, fresh air, good food and careful nursing could save lives. Nightingale's fame made nursing look more respectable for women, and the newspaper reports made the public and the government take hospital conditions seriously.

What stayed the same: nobody yet knew that germs caused disease. People still thought in terms of miasma, so cleaning the air and removing the filth seemed the right thing to do, without anyone knowing why it worked. The Crimean War still ended with many more British soldiers dead from disease than from fighting.

Exam-style question

Explain TWO causes of the fall in the death rate in the Barrack Hospital at Scutari in 1855. [8 marks]