Florence Nightingale, War, and Disease

(Written for 9terrains, March 2016. Used with permission.)

Cannon to right of them,

Cannon to left of them,

Cannon in front of them

Volleyed and thundered;

Stormed at with shot and shell,

Boldly they rode and well,

Into the jaws of Death,

Into the mouth of hell

Rode the six hundred."

— Alfred, Lord Tennyson; "The Charge of the Light Brigade"

In 1854, the British nurse Florence Nightingale (1820-1910) reported to a British Army hospital in Scutari, across the Black Sea from the Crimean peninsula in what is now Turkey, during the Crimean War (1853-1856). She brought 38 volunteer nurses with her.

Conditions in the hospital were squalid. Nightingale and her team of nurses quickly found that far more soldiers were dying from disease—including cholera, dysentery, and typhus—than from wounds sustained in combat. For every one soldier who died from combat wounds, ten would die from disease.

The Crimean War was among the most destructive of the 19th century. Out of 310,000 French soldiers who fought in the war, as many as 100,000 died. Great Britain lost about 20,000 out of 98,000 soldiers. Many thousands of civilians also died as a result of the fighting, disease, and starvation. The war broke out in 1853 between the United Kingdom, France, Sardinia, and the Ottoman Empire on one side; and the Russian Empire on the other. It ended with Russia's defeat in 1856.

Nightingale's role at Scutari was primarily that of hospital administrator, with her team of nurses treating patients. In this capacity, Nightingale could see the big picture. She saw that soldiers were often left unattended, or even untreated, in the military hospital. Nightingale met with resistance from military officials, who resented that, as a civilian, she was outside their chain of command. She needed a way to communicate the critical need for better treatment procedures, not just at Scutari, but at all British military hospitals.

As a hospital administrator, the data Nightingale was able to obtain gave her what she needed to make her case. She created a type of graph known as a polar-area diagram, or "coxcomb," to visually depict the number of deaths caused by diseases, compared to deaths caused by combat.

Nightingale's coxcombs provided undeniable evidence of the need for improved sanitation and hygiene in military hospitals. The deadliest month of the war for British soldiers, January 1855, saw 3,168 fatalities. Only 83 of those deaths were due to wounds, while 2,761 were directly attributable to disease.

Nightingale printed her statistical analyses, including the coxcombs, in pamphlet form. She distributed copies to military officials and members of Parliament, lobbying to have the reforms she oversaw at Scutari instituted in all military hospitals.

Her work revolutionized hospital administration and brought prominence to the issue of public health. In fact, the first two new military hospitals built in Great Britain after the war proved to be too large, because improvements in sanitation and hygiene inspired by Nightingale's work resulted in fewer instances of illness. Nightingale reportedly replied to this news with "Really it is not our fault if the number of sick has fallen so much that they can’t fill their hospitals."

© David C. Wells 2014