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A* A level History A2 - Historians have disagreed about the effectiveness of Florence Nightingale's work during the Crimean war. What is your view on the effectiveness of Florence Nightingale's work? This essay examines the h$27.93
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A* A level History A2 - Historians have disagreed about the effectiveness of Florence Nightingale's work during the Crimean war. What is your view on the effectiveness of Florence Nightingale's work? This essay examines the h
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History Coursework
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PEARSON (PEARSON)
This essay examines the historical legacy of Florence Nightingale’s work, focusing on the efficacy of her work during the Crimean War.
Historians have disagreed about the effectiveness of Florence Nightingale's work during the
Crimean war. What is your view on the effectiveness of Florence Nightingale's work?
Introduction
This essay examines the historical legacy of Florence Nightingale’s work, focusing on the efficacy of
her work during the Crimean War. Recent academic debate has placed her early record as a nurse
during the Crimean War under scrutiny and some historians have sought to revise her reputation as
a successful reformer during her tenure working in the military hospital in Scutari. Whilst this essay
focuses on her work with respect to the Crimean War, it is important to bear in mind that her
reputation as a successful reformer is not built solely upon this conflict nor upon the efficacy of her
reforms during her lifetime only, but with respect to her work both as a researcher and her legacy in
instilling new standards for nursing practice that have extended beyond her own lifetime.
This essay assesses Nightingale’s work during the Crimean War from the perspective of the
debate among historians regarding her effectiveness during this time. This is carried out primarily
through the summary and analysis of the arguments for and against her effectiveness as presented
across three texts: Hugh Small’s 1998 biography Florence Nightingale: Avenging Angel, Christopher
and Gillian Gill’s 2005 journal article, ‘Nightingale in Scutari: Her Legacy Re-Examined’, and Lynn
McDonald’s 2010 treatise Florence Nightingale at First Hand.1
Nightingale’s Work and Legacy
Before assessing the arguments presented across the historical works mentioned above, it is first
necessary to outline some of Nightingale’s key achievements as it is the effectiveness of these works
that the historical accounts assess. Nightingale’s early life involved a level of education unusual for
women though not unheard of for women of her upper middle class background, though her
primary derivation from the expectations of her class was the decision to enter into a vocation and
become a nurse.
Nightingale’s rise to prominence came originally as a result of her contributions to nursing
following the Crimean War. Nightingale travelled to Scutari, near Constantinople, along with
hundreds of volunteer nurses in 1854, where conditions prior to her arrival were already commonly
known to be poor. She and the volunteer nurses found that the barracks hospital was understaff and
that hygiene was very poor, leading to a higher than usual rate of infection. Medicines were also in
short supply and many of the injured or ill soldiers were malnourished. Of the thousands of soldiers
that died during the Winter of 1854, the vast majority perished from disease as opposed to wounds
sustained in battle.
Nightingale’s first contribution came from a letter she sent to The Times newspaper that
argued for government intervention to improve conditions at the hospital. The solution arrived at
what was an assembled hospital known as Renkioi hospital, designed by Isambard Kingdom Brunel
and managed by one of the city’s preeminent physicians, resulting in a significant drop in the
mortality rate as compared with the previous barracks hospital. Newspapers and periodicals of the
time also attributed the reduction in the death rate to Nightingale’s implementation of hygiene
1
H. Small, Florence Nightingale: Avenging Angel (New York: St Martin’s Press, 1998); C.J. Gill & G.C. Gill,
‘Nightingale in Scutari: Her Legacy Re-Examined’, Clin Infect Dis., vol. 40, no. 12 (2005), pp. 1799-805; L.
McDonald, Florence Nightingale at First Hand (London & New York: Continuum, 2010).
, procedures, assisting in her elevation to public fame and the image of her as ‘The Lady with the
Lamp’.
This image of Nightingale as attending bedsides in military hospitals is arguably somewhat at
odds with the lesser known image of Nightingale throughout her later career. Suffering from poor
health, Nightingale retired from nursing following the Crimean War, though continued to write and
publish from her home for many years. She wrote handbooks on nursing that attempted to establish
better knowledge and procedures for nurses, as well as contributing to research through extensive
statistical work on sanitation. Returning to the Crimean War as a case study, Nightingale prioritised
sanitation reform as a means of improving hospitalisation outcomes at a time where rudimentary
theories of how infection and disease spread would otherwise not have recommended such
measures.
Historical Assessments
The above summary of Nightingale’s work and achievements demonstrate how much of her later
legacy owed to her statistical analysis of the Crimean War as a case study. However, some historians
have argued that Nightingale’s contribution to nursing during her time in the Crimea itself has been
exaggerated. This section explores contributions to this debate made by several historians with
respect to her work throughout the Crimean War specifically.
Small’s Avenging Angel
Hugh Small’s biography of Nightingale focuses primarily on the period after her time spent in the
Crimea and following her self-imposed retreat from public life to private writing, publication and
campaigning. Referring to Nightingale as ‘history’s most famous invalid’, Small attributes this self-
confinement and subsequent obsession with sanitation reform as resultant from Nightingale’s
realisation of her own culpability in over fifteen thousand deaths in military hospitals during the
Crimean War.2 Small argues that Nightingale’s guilt regarding her own performance as a nurse
during the Crimean War precipitated a breakdown and a lifelong commitment not simply to
improving hospital sanitation but to proving the efficacy of sanitation improvements as justification
of her own efforts throughout the Crimean War.
Small evidences these claims largely through analysis of primary sources but places
emphasis on what documentation has been lost as well as what survives. Much of this focuses on
Nightingale’s destruction of her own wartime correspondence as well as the exclusion of her
evidence from the report of the Sanitary Commission. In particular, her destruction of
correspondence with William Farr in 1857 is deemed to be significant given that she appears to have
come to accept his conclusions regarding the high mortality rate in Scutari across this period. 3
Small argues that this is the case on account of one surviving letter in which she blames
military authorities originally for sending wounded soldiers too late to the hospital, doubting Farr’s
account of the high death rate as caused by ‘bad air’: ‘The physically deteriorating effect of the
Scutari air has been much discussed but it may be doubted. The men sent down to Scutari in the
winter died because they were not sent down till half dead – the men sent down now live and
recover because they were sent in time’. 4 Small contrasts this letter, sent in 1855, with one sent two
years later in which Nightingale states that she has informed Queen Victoria that her soldiers died
2
Small, Avenging Angel, p. 1.
3
ibid., pp. 178-9.
4
ibid., p. 179.
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