Civil War Medicine: Florence Nightingale, The Influencer

While every woman who volunteered to nurse during the Civil War had their own reasons for doing so, one of the more popularly cited motivators for these women was not even American. Florence Nightingale, the “Lady with the Lamp” who served as a nurse during the Crimean War (1853-1856), became what we may modernly dub as an “influencer,” someone who has established credibility in a specific industry, has access to a huge audience, and can persuade others to act based on their recommendations. She became a driving force in military medical reform and her books, Notes on Nursing (1859) and Notes on Hospitals (1859), impacted American audiences. She made such an impact that women nurses in the Civil War were sometimes referred to as “Nightingales.”[1] However, some scholars and historians have published critical views on the true effects of Nightingale’s service as a nurse. After all, a soldier was less likely to die in a field hospital than if they were transferred to her hospital in Scutari even after she arrived with her team of nurses.[2] Her fame as a gentle and compassionate Victorian nurse has persisted, despite doubts that she made a difference at all at Scutari.

Nightingale came from a well-to-do British family, born into a life of ease and luxury in 1820.[3] She never married and felt out of place in society. Her parents were initially displeased with her announcement that she wanted to become a nurse. It simply “wasn’t done” for a high society Victorian woman to enter a hospital and work, surrounded by wounded, diseased, or socially aberrant people under the supervision of a male doctor with no chaperone or escort. It was outside of the domestic sphere and generally not a welcoming place to women, but Nightingale as well as many other women of the age felt a need to do their part in the Crimean War after the British government made a call for nurses. She and 38 nurses were sent to the hospital at Scutari near Constantinople and when they arrived in November of 1854, were met by what we may refer to as a “dumpster fire” in terms of medical cleanliness and organization. An assistant surgeon wrote in January of 1855, “All were swarming with vermin, huge lice crawling all about their persons and clothes. Many were grimed with mud, dirt, blood and gunpowder stains. Several were completely prostrated by fever and dysentery. The sight was a pitiable one and such as I had never before witnessed.”[4]

What Nightingale brought to Scutari was a level of command and organization that was initially resisted by the medical officers and surgeons at the hospital. Much like the doctors of the Civil War, they did not see the hospital as the proper place for a woman. However, as the casualties came rolling in, Nightingale and her nurses stepped up to the challenge of taking care of the personal hygiene of the soldiers. In her book, Notes on Nursing, she imparts principles of cleanliness such as providing a balanced and healthy diet for the sick, providing fresh air and ventilation to the sick chambers, and being sure not to aggravate the mental or emotional condition of the patient. She writes on her advice that it all required “common sense and care. Yet perhaps in no one single thing is so little common sense shown, in all ranks, as in nursing.”[5] Much of what she advises seems to make sense, looking backward on the unsanitary conditions of the hospitals of the era. Yet, men continued to die in droves at Scutari, despite her militant order over the hospital. It wasn’t until the British government sent a sanitary commission to Scutari to investigate that additional measures were carried out to clean up the hospital. While Nightingale focused on personal hygiene, the environmental hygiene of the hospital suffered. The ideas of ventilation, the flushing of human waste, and maintaining ward cleanliness improved conditions at Scutari and were adopted by Nightingale in her books.[6] The death rate dropped significantly as a result of their improvements, declining from 42% in February to 2% by June.[7] She remained in the Crimea, working mostly at Scutari and Balaclava until the end of the war in 1856 when she returned home. For the rest of her life, she lobbied for medical reform and blamed poor sanitation for the high death tolls in army hospitals.

So, if Nightingale was not the only force behind military hospital improvement, why did she earn such a glowing reputation when there were others who helped at Scutari? Nightingale may not have been the pivotal factor in turning around Scutari, but she certainly helped and her superior sense of organization did make a difference. Her rapport with the soldiers alone gained her widespread fame. Her attentiveness to the needs of the soldiers, seeing them as more than cannon fodder but as fellow humans in need of mending was near revolutionary for the men who fought in the Crimean. She advocated for nursing as a way of “saving life and increasing health and comfort” rather than gently easing them into death through neglect.[8] She made the rounds through the hospital ward with her lantern, earning her the whimsical name of “Lady with the Light.” One of her many biographers wrote, “She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.”[9]

This image of the graceful, angelic nurse inspired the feminine American masses to replicate her service during the Civil War. Women could draw on Nightingale as an example of the respectable woman who also nursed the sick and wounded, anchoring their rationale in her own words that “every woman is a nurse.”[10] Witnesses of the trend were quick to point out the resemblances between the enthusiastic volunteers of the Civil War and the strong-willed woman at Scutari. “The young ladies are exceedingly anxious to imitate Florence Nightingale,” remarked one observer. The Daily Journal of Wilmington, North Carolina commented, “We now have in active service another generation of Spartan women, whose ranks are filled with whole legions of Florence Nightingales.”[11]

Some saw the women and young ladies, North and South, buying into the romantic notion of the wartime nurse that Nightingale embodied and were not as convinced to their authenticity to the cause, writing, “In fact, many ladies wanted to imitate Florence Nightingale, but who had not prepared themselves by study or practice in the art of nursing, and who having some success at home nursing… were greatly at sea when they undertook to look after numbers of rough soldiers with few of the appliances at home.” Indeed, even Nightingale wrote that “it is impossible to learn [nursing] from any book, and that it can only be thoroughly learnt in the wards of a hospital.”[12]

Nightingale is still revered as one of the most influential reformers of the Victorian era, pioneering sanitation transformation in military and civilian medicine. Her influence reached across the pond, inspiring other women to follow in her footsteps. Her activism for proper war ventilation is also cited as inspiration in the architectural design of hospital wards.[13] Whether it was her idea for the ventilation or not, her image and social action made the difference for Americans who struggled through the Civil War.

End Notes

[1] Civil War Med, p. 408

[2] She found that soldiers were more likely to survive if they stayed in the hospitals at the front (which had a 12.5 per cent mortality rate) than if they were transferred to the hospital in Scutari (which had a 37.5 per cent mortality rate). “Florence Nightingale: The Lady with the Lamp.” n.d. Nam.ac.uk. Accessed September 26, 2022. https://www.nam.ac.uk/explore/florence-nightingale-lady-lamp.

[3] I. Bernard Cohen, “Florence Nightingale,” Scientific American, Vol 250, March 1984, p. 128–137

[4] Quoted in “Florence Nightingale: The Lady with the Lamp.” n.d. Nam.ac.uk.

[5] Notes, p. 19

[6] Kathleen Koenig & Janice Hayes, Professional Nursing Practice: Concepts and Perspective, Pearson, 2011, p. 100

[7] Lee, Sidney, ed. “Nightingale, Florence,” Dictionary of National Biography (2nd supplement). Vol. 3. London, Smith, Elder & Co., 1912, p. 17 (accessed archives.org)

[8] Notes, p. 124

[9] E. T. Cook, The Life of Florence Nightingale, Vol 1, 1913, p 237.

[10] Notes, p. 7; Union, p. 196

[11] Quoted in Miller, Empty Sleeves, p. 93; Daily Journal (Wilmington, NC), October 3, 1861

[12] Fanning Wood, Doctor to the Front: The Recollections of Confederate Surgeon Thomas Fanning Wood, Donald C. Koonce, ed., (Knoxville, TN, 200), p. 36; Notes, p. 128

[13] Civil War Medicine, p. 219