3. Who Was Florence Nightingale and What Did She Do for Scotland?

Nightingale was the major founder of the modern profession of nursing, a health care pioneer, originally famous for leading the first team of British women to nurse in war, the Crimean War of 1854-56.

The Bicentenary of her birth (May 12, 1820) will be celebrated in 2020, we hope not just during Nursing Week, but throughout the year, with a new look at her key ideas and their relevance today.

While Nightingale was well known in her lifetime, and for a long time after it, she is now often mis-represented. Her best-known book, Notes on Nursing, came out in 1860, the same year that her training school opened. She wrote many books and reports, on nursing, hospital safety, and health care more broadly.

She is also a major pioneer of evidence-based health care. She was instrumental in getting professional nursing into the workhouse infirmaries, the first step towards their becoming regular hospitals. The National Health Service could hardly have begun operations in 1948 without the great improvements made in the old workhouses, when 80% of hospital patients went to them. Nightingale believed in quality care for all, regardless of ability to pay.

She was instrumental in making nursing an attractive, well-paid career, when “nurses” had been disreputable hospital employees, mainly cleaners, and often drunk. However, she considered that the “cardinal sin” of unreformed nursing was demanding bribes from patients. She worked mightily also for improved hospital safety, for nurses, doctors and patients.

“A nurse must not be a scrubber. And a scrubber cannot be a nurse” (Nightingale, Notes on Hospitals).

Scotland: Nightingale knew it from travels as a child and young person. In 1856, after her return from the Crimean War, she was invited to Balmoral Castle to meet with Queen Victoria, Prince Albert and the war minister, Lord Panmure. Panmure commissioned her to write a report on the war hospitals, and what went wrong (they had very high death rates, which were brought down). She was in touch with leading Scottish doctors and was instrumental in founding nurse training in Scotland.

Collaborators in research and policy. Two of Nightingale’s closest allies were Scottish-trained doctors sent to the Crimean War to clean up the hospitals: Dr. John Sutherland, head of the Sanitary Commission, and Sir John McNeill, head of the Supply Commission. Post-Crimea, Dr. Sutherland became, in effect, her research associate, providing medical information and drafting material for her.

Edinburgh surgeon James Syme was a pioneer in the use of chloroform, probably Nightingale’s source for the supplies she took to the Crimean War.

She corresponded with Sir James Y. Simpson on “hospitalism,” or health care-acquired infections. Edinburgh nutrition expert, Sir Robert Christison was her collaborator in improving food in the army.

Edinburgh Royal Infirmary: This large and famous hospital, with its highly regarded medical school, was notorious for sanitary defects and disreputable “nurses.” It was a “beastly den of thieves.” This changed when a new director was appointed: C.H. Fasson, who had practiced in army hospitals, both without and with trained nurses. He asked Nightingale to get them trained nurses, which she did. They started in late 1872.

It became, in effect, a second “Nightingale school,” and, as the first, in London, sent out trained nurses and matrons to introduce professional nursing elsewhere. Angelique-Lucille Pringle, its second trained matron, led the nursing there from 1873 to 1887, when she accepted appointment as matron at St. Thomas’ Hospital, London.

In 1879, its new, pavilion-style, building was opened, with excellent ventilation, 2300 to 2500 cubic feet per bed. It remained in operation until 2002. Late in her life, Nightingale called the Edinburgh Royal Infirmary “the best hospital” in the United Kingdom, both for nursing and organization. She regularly sent doctors and nurses visiting from other countries to see it.

Glasgow Royal Infirmary. Professional nursing was started there by Rebecca Strong, a “Nightingale nurse,” meaning one who trained at the Nightingale School at St. Thomas’. Nightingale was not as involved with the Glasgow infirmary as she had been with Edinburgh, but she is recognized there with a fine marble statue in the vestibule, next to a bronze relief of Joseph Lister (who pioneered antiseptic surgery there) and Rebecca Strong, the first trained matron. Strong earlier had been the first trained matron at the Royal Dundee Infirmary.

Short paperbacks on Nightingale by Lynn McDonald are:
Florence Nightingale at First Hand (Bloomsbury and Wilfrid Laurier University Press, 2010); Florence Nightingale: A very brief history (SPCK 2017); and Florence Nightingale, Nursing and Health Care Today (Springer, 2018).

The Nightingale Society promotes knowledge of her great contribution to nursing and public health care and its relevance today. It defends her reputation and legacy when attacked. To get onto the list for (occasional) updates: contact@nightingalesociety.com or www.nightingalesociety.com.

A printable PDF version of this paper can be downloaded in either 8 1/2″ x 11″ letter-sized (US and Canada) or 210mm x 297mm A4 (European) format: 3-nightingale-and-scottish-healthcare.pdf (letter, 2 pages) | 3-nightingale-and-scottish-healthcare-a4.pdf (A4, 2 pages)