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In May 1857 a Commission to study the whole question of the army medical service began to sit. The price was high. Florence Nightingale was doing this grueling work because it was vital, not because she had chosen it. She had changed. Now she was more brilliant in argument than ever, more efficient, more knowledgeable, more persistent and penetrating in her reasoning, scrupulously just, mathematically accurate—but she was pushing herself to the very limits of her capacity at the expense of all joy.

That summer of 1857 was a nightmare for Florence—not only was she working day and night to instruct the politicians sitting on the Commission, she was writing her own confidential report about her experiences. All this while Parthe and Mama lay about on sofas, telling each other not to get exhausted arranging flowers.

It took Florence only six months to complete her own one-thousand-page Confidential Report, Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army. It was an incredibly clear, deeply-considered volume. Every single thing she had learned from t Crimea was there—every statement she made was backed by hard evidence.

Florence Nightingale was basically arguing for prevention rather than cure. It was a new idea then and many politicians and army medical men felt it was revolutionary and positively cranky. They grimly opposed Florence and her allies.

She was forced to prove that the soldiers were dying because of their basic living conditions. She had inspected dozens of hospitals and barracks and now exposed them as damp, filthy and unventilated, with dirty drains and unventilated, with dirty drains and infected water supplies. She showed that the soldiers’ diet was poor. She collected statistics which proved that the death rate for young soldiers in peace time was double that of the normal population.

She showed that, though the army took only the fittest young men, every year 1,500 were killed by neglect, poor food and disease. She declared “Our soldiers enlist to death in the barracks”, and this became the battle cry of her supporters.

The public, too, was on her side. The more the anti-reformers dragged their feet, the GREater the reform pressure became.

Florence did not win an outright victory against her opponents, but many changes came through. Soon some barracks were rebuilt and within three years the death rate would halve.

The intense work on the Commission was now over, but Florence was to continue studying, planning and pressing for army medical reform for the next thirty years.

People now began to demand that she apply her knowledge to civilian hospitals, which she found to be “just as bad or worse” than military hospitals. In 1859 she published a book called Notes on Hospitals. It showed the world why people feared to be taken into hospitals and how matters could be remedied.

Florence set forth the then revolutionary theory that simply by improving the construction and physical maintenance, hospital deaths could be GREatly reduced. More windows, better ventilation, improved drainage, less cramped conditions, and regular scrubbing of the floors, walls and bed frames were basic measures that every hospital could take.

Florence soon became an expert on the building of hospitals and all over the world hospitals were established according to her specifications. She wrote hundreds and hundreds of letters from her sofa in London inquiring about sinks and saucepans, locks and laundry rooms. No detail was too small for her considered attention. She worked out ideas for the most efficient way to distribute clean linen, the best method of keeping food hot, the correct number of inches between beds. She intended to change the administration of hospitals from top to toe. Lives depended upon detail.

Florence Nightingale succeeded. All over the world Nightingale-style hospitals would be built. And Florence would continue to advise on hospital plans for over forty years. Today’s hospitals with their flowers and bright, clean and cheerful wards are a direct result of her work.















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