Covid-19 has reminded us of power in Nightingale lamp light
MAY 12, 1820. Today, Ms William Nightingale, nee Frances Smith, is safely delivered of a daughter. The couple’s second child will be named for the Italian city in which she is born: Florence.
Florence Nightingale was born 200 years ago today in an airy, 16th-century villa in the Florence hills, amid the screeching and wheeling of swallows, the heady scent of roses. The luminous, luxurious nativity at the pristine La Colombaia is about as far as it is possible to be from the Crimean scenes that made her name, giving us what we know today as triage, hospital epidemiology, health hygiene, sanitary disposal, infection control and isolation. And, of course, the pie chart.
To understand what she faced, an eyewitness account of Balaklava, published by the academics Christopher and Gillian Gill, puts it best.
“If anybody should ever wish to erect a ‘Model Balaklava’ in England, I will tell him the ingredients necessary... On to one part of the beach drive all the exhausted bât ponies, dying bullocks, and worn-out camels, and leave them to die of starvation. They will generally do so in about three days, when they will begin to rot, and smell accordingly. Collect together for the water of the harbour all the offal of the animals slaughtered for the use of the occupants of above 100 ships, to say nothing of the inhabitants of the town – which, together with the occasional floating human body, whole or in parts, and the driftwood of the wrecks, pretty well covers the water – and stew them all up together in a narrow harbour, and you will have a tolerable imitation of the real essence of Balaklava.”
Only in 1854, Balaklava is too tame for Florence Nightingale. She is ordered to the military hospital at Scutari, a fortnight’s crossing on ships heaving with the contagious and diseased. Scutari is effectively a Lazaretto, the infected sent there to die, more than to recover. If its 6km of wards stink, slosh with sewage, then they blaze with fever: cholera and dysentery, typhoid and typhus, malaria, gangrene, wild respiratory infection.
Lice “devour” their victims before “swarming” to the next. Patients smother in the reek of sweat and bandages, feral and ferrous, the camphor bite of phlegm, the whitethorn stench of pus. Her words on arrival are widely published: “the strongest will be needed at the wash-tub”.
Celebrating the 200th anniversary of Florence Nightingale’s birth at a time of new infection and contagion is apposite. ‘Wash Your Hands, Stay Home’ must be epidemiological music to the ghost ear of the woman who revolutionised clinical practice by her Sanitarian approach: rigorous hygiene to be maintained by all who attend the wards or are treated there; fresh cloths to clean the wounds of each patient; regularly changed dressings; fresh bedlinen and bedwear; good light and ventilation; safe disposal of human and medical waste; avoiding of contagion and contamination by isolating the infected.
In 1854, Nightingale, the recognised expert in fever nursing, is horrified that on the Crimea, more men are dying of infection than in battle. She suggests to friends in politics that she, and a team, would deploy to its hospitals.
When British War Secretary Sidney Herbert asks her to do just that, she’s off. But while the nurse’s motivation is Light, the politician’s is Heat. Specifically, the white heat of public opinion that sees the army accused of negligence to its men and threatens the stability of government. Slaughterhouse conditions are nothing new to British military hospitals. What is new, however, is that people know about them, care and protest.
The Nightingale in Scutari analysis puts it down to media and technology. Daily reports in the London ‘Times’, filed via the new telegraph, set a fire under the government, to do something for the men and to be seen to do so.
Today, in the public-political dynamic of the image and the optics, not much has changed. With Covid-19, we see it in medical staff highlighting their lack of PPE, nursing-home workers taking to social media to highlight political abandonment, grieving relatives talking to the media about the abject virus conditions of people they love.
Until I saw her birthplace, I wasn’t much interested in Florence Nightingale. Administering lamp-lit saccharine succour to an imperial force within a first fattening after the Famine was problematic.
Nor could I get beyond the dour Victorian figure with cap and coils, her genie lamp in hand, redolent more of Billa Connell in the panto as Ali Baba’s Auntie, than medical revolution on the Crimea. But the real and radical Florence Nightingale was a revelation: a polymath who defied social mores and constraints, her interest in mathematics, statistics and management, alive in every line of her meticulous records. Her diligence in writing everything down makes perfect sense for a woman born in Florence. For centuries, Florentines kept detailed accounts of every aspect of their work and lives.
It’s no surprise that these
meticulous records brought her into conflict with the army, both its officers and surgeons.
A vast, military post-mortem on what happened at Scutari manages to make no mention of Nightingale and her nurses, despite her revolutionising treatment and her personal funding of laundries, kitchens, bedlinens, new flooring, good clothes and food for the men.
In fact, the Gills point out how when her account exposed and contradicted that of the barracks’ chief medical officer, Dr Duncan Menzies, he did his damnedest to “thwart” her. According to him, the army “had everything” and “nothing was wanted”. Here’s Nightingale as a Victorian Captain Crozier. And indeed, a late Dr Abdul Mabud Chowdhery warning the Johnson government about the lack of PPE.
Nightingale came home from the Crimea to a hero’s welcome. In 1860, she set up the world’s first secular nursing school at St Thomas’s Hospital, where Boris Johnson was treated in ICU. Some believe that reducing a radical reformer to the Lady With the Lamp diminishes, demeans her. With Covid, especially, I believe the opposite is true.
Her presence on the wards brought comfort to men rendered invisible through poverty, illiteracy or contagion, or considered cancelled through statistics, or in their dismantling by society or the military.
Crucially, in her nightly rounds, she told them she saw them. On the bicentenary of her birth, on these two islands we need way more visibility, way more seeing.
In the next phase of our own fever, the nurses, doctors, till operators, shelf-stackers, delivery people, bus drivers cannot, again, become politically invisible and therefore discountable and disposable.
If Covid-19 has taught us anything it’s that politically, globally, we need Nightingale’s scouring and scrubbing revolution; the social wounds carefully tended, the fresh linens, decent space, good food, the big windows thrown open to let in the light, the air.
And, in the virus dark, collectively, we must light the lamps: be safe, by being seen.