Florence Nightingale

As a young girl, I acquired a fascination with Florence Nightingale and her nursing career, but had mostly ignored her in my adult life, assuming that I knew all I needed to know of her. Last week, as I perused the bargain table at Barnes & Noble, I couldn't resist picking up her Notes on Nursing. I have read biographies and historical fiction, but never her own words.

It is astonishing that as recently as the 19th century, her advice to the medical world - which has become part of the canon of common sense among all civilized peoples - was revolutionary. Her actute sense of responsibility and observation, coupled with her willingness to speak against commonly accepted practices, even in the face of ridicule, radically altered the art of nursing.

I've summarized her "revolutionary" recommendations below:

1) Ventilation & Warming - Without the benefits of technology (air conditioning, construction techniques, etc.), the best Florence could recommend was to abandon the harmful practice of shutting up the sick in their rooms, which caused them to "repeatedly breathe their own hot, humid, putrescing atmosphere...a certain way to delay recovery and destroy life." Her solution was to light a fire to maintain warmth, then open all the windows and doors for air circulation. Sounds pretty basic, doesn't it? But the fear of spreading disease was so great, that the sick were quarantined in conditions that left them in extreme temperatures and without ventilation of any sort!

2) Noise - Do not unsettle a patient with sudden or unnecessary noises, including excessive talking or hustle and bustle. The nurses' necessary movements ought to be decisive, quick and subtle, creating the least inclination to tension and the greatest inducement to sleep.

3) Variety - The sick should not be left to flounder within the same four walls without variation of view or surroundings. "The effect in sickness of beautiful objects, of variety of objects, and especially of brilliancy of color, is hardly at all apprehended." If a patient is unable to leave the sick room, vary the surroundings by rearranging, changing artwork or plant life.

4) Diet - Miss Nightingale expounds on the importance of both the circumstances under which food is offered, as well as the substance of the diet. It is essential to determine when the patient has the greatest appetite and inclination to eat...which may not have anything to do with normal eating hours and may not be convenient. As for content...she suggests heavy use of butter, cream and cheese (how can that be bad??!) because small amounts can pack a hearty punch of nutritive value. Above all, she demands that all food for the sick should be well-cooked so that their over-taxed systems have less work to do to process the food.

5) Bed & Bedding - Her descriptions of bodily emanations permeating linens and mattresses are more than a little repulsive, but of course, in her day, they lacked the technologies of breathable fabrics, spring mattresses, and washing machines! Airing beds and bedding was a laborious task which was easily and often neglected. She insisted it be done quite regularly, even if it meant putting two beds in the sick room and switching the patient every day so that the previous day's bedding could be aired out of doors.

6) Light - "The cheerfulness of a room, the usefulness of light in treating disease is all-important." Especially direct sunlight, to which the sick should be exposed from sunrise to sunset, if at all possible. Bag the heavy curtains, open the windows and situate the bed so that the sunlight is visible to the patient.

7) Cleanliness - Furnishings, walls and floors were too often "cleaned" by featherdusting, which she argued only stirred up and shifted the dirt from one place to another. Instead, she suggested using a damp towel to remove the dust and dirt from all surfaces. "Very few people, be they of waht class they may, have any idea of the exquisite cleanliness required in the sick room." She also brought a new standard to patient-cleanliness as well. "Just as it is necessary to renew the air round a sick person frequently, to carry off morbid effluvia from the lungs and skin, by maintaining free ventilation, so is it necessary to keep the pores of the skin free from all obstructing excretions. The object, both of ventilation and of skin-cleanliness, is pretty much the same, - to wit, removing noxious matter from the system as rapidly as possible."

8) Chattering Hopes & Advice - Florence believed that visitors could do either a great deal of good or harm for a patient, depending on their approach. "In general, patients who are really ill, do not want to talk about themselves." And the last thing they need is for YOU to tell them they're going to be fine or to offer your own "medical" opinion. "The long chronic case, who knows too well himself, and who has been told by his physician that he will never enter active life again, who feels that every month he has to give up something he could do the month before - oh! spare such sufferers your chattering hopes. You do not know how you worry and weary them. Such real sufferers cannot bear to talk of themselves, still less to hope for what they cannot at all expect. No mockery in the world is so hollow as the advice showered upon the sick."

Instead, she advises, "a sick person does so enjoy hearing good news...show them what the rest of the world is doing! Instead of advising him with advice he has heard at least fifty times before, tell him of one benevolent act which has really succeeded practically, - it is like a day's health to him...remember how their life is to them disappointed and incomplete. You see them lying there with miserable disappointments, from which they can have no escape but death, and you can't remember to tell them of what would give them so much pleasure, or at least an hour's variety?! ...they like you to be fresh and active and interested." Bring in little children and babies, she says! "It freshens up a sick person's whole mental atmosphere to see 'the baby.'"

Finally, Miss Nightingale's description of what a nurse ought to be is noteworthy:

"...she must be no gossip, no vain talker; she must be strictly sober and honest; but more than this, she must be a religious and devoted woman; she must have a respect for her own calling, because God's precious gift of life is often literally placed in her hands; she must be a sound, and close, and quick observer; and she must be a woman of delicate and decent feeling."

If you are unfamiliar with Florence's life and work, I suggest you get to know her! Unfortunately, I cannot recommend a particular biography, because I don't remember which ones I read as a child, but the Landmark historical fiction series is always good and I know they tell her story (they're out-of-print, but readily available online). If any of you has a recommendation, please make it!