by Lynn McDonald, for the Nightingale Society

Florence Nightingale (1820-1910) was an early and persistent advocate of the best means to prevent the spread of infectious diseases—frequent handwashing—calling for it in her 1860 Notes on Nursing, and adding details on the use of disinfectants in later writing. She was a pioneer of evidence-based health care, from the lessons learned from the high mortality rates of the Crimean War (1854-56).

The National Health Service, in giving the name “Nightingale Hospital” to five temporary hospitals for COVID-19 patients, is recognizing her relevance to combatting infectious diseases. Note the parallels:

1. Nightingale’s own Crimean War Barrack Hospital had 4000 beds in 1854 and was then the largest in the world. It had high death rates, which were brought down dramatically by the introduction of strict sanitary measures. She herself documented the decline in deaths in a comprehensive analysis after the war.
2. There are great similarities between the infectious diseases (fevers and bowel diseases) of Nightingale’s day and the coronavirus of ours: no vaccine or effective treatment for any of them. Health care workers help the patient through the crisis, now with respirators, and there is now (when available) better protective equipment for them. Given the advances in medical sciences since Nightingale’s day, however, the prospects of a vaccine and/or effective treatment for COVID-19 are great.
3. Nightingale and her team of experts learned the lessons of the Crimean War and went on to press, successfully, for higher standards in ventilation, cleanliness and clean water (through improved sewers and drains) in hospitals, barracks, towns and rural areas. The new standards worked–death rates declined.
4. Evidence of this success can be seen in the declines in the number of hospital beds the British Army needed. The vast army hospital that was built after the war, at Netley on the south coast of England, was over-built, its number of beds based on the usual pre-Crimea percentage. That hospital was not filled to capacity until the Boer War of 1899-1902, more than 30 years after it opened. Nightingale joked to her MP brother-in-law, Sir Harry Verney: “Really, it is not our fault if the number of sick has fallen so much that they can’t fill their hospitals.”
5. Collecting the necessary data. After the Crimean War, and learning its lessons, Nightingale began to call for systematic improvements in data collection, both for the military and general population. Epidemics have to be identified and tracked, without delay. Good weekly data on disease and death had to be produced, to become daily data as an epidemic appeared. Nightingale called for data on health status and housing (as a major determinant of disease) to be collected routinely as part of the Census.
6. One last parallel from then to now: the first NHS Nightingale Hospital (in London’s Docklands) was officially opened by Prince Charles, from his residence at Birk Hall, on the Balmoral estate in Scotland. Nightingale herself stayed at Birk Hall in 1856, when it was the home of Queen Victoria’s physician, Sir James Clark, a Nightingale ally. The Queen, Prince Albert and Nightingale together, at Balmoral, pressed Lord Panmure, the secretary of state for war, for a study to be done of what went wrong in the high death-rate Crimean War hospitals. This became Nightingale’s 853-page Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army¸ 1858.

Will the lessons of this coronavirus pandemic be learned? It happens that different countries/states have adopted different measures of prevention, from thorough lockdown to mere voluntary social distancing. The amount of testing done has also varied enormously from substantial numbers to only the worst cases. Thus, like it or not, the elements of an experiment are in place. What gets the best results– the lowest number of deaths per population?

This pandemic is likely to carry on for some time, and/or return in later waves. We need medical experts to find an effective vaccine and methods of treatment. As well, especially while waiting for such developments, we need Nightingale-type research, to assess the success (or not) of the various measures used to limit that spread.