Dan Snow's History Hit - Florence Nightingale

Episode Date: April 26, 2020

For soldiers of the Crimean War, perhaps the greatest adversary they faced was the Selimiye Barracks in Scutari, a makeshift hospital for wounded men. A lack of hygiene, medicine and compassion made this a living nightmare - if you didn't perish from your wounds, you would probably succumb to one of the mass infections which plagued the barracks. But one nurse changed all that, Florence Nightingale, who is commonly considered the founder of modern nursing. Professor Lynn McDonald took me through the incredible work of Nightingale, highlighting her importance as a social reformer and statistician. In light of the current world pandemic, we also discussed how Nightingale would have set out to combat the challenges of COVID-19. For ad free versions of our entire podcast archive and hundreds of hours of history documentaries, interviews and films, including our new in depth documentary about some of the greatest speeches ever made in the House of Commons, please signup to www.HistoryHit.TV Use code 'pod1' at checkout for your first month free and the following month for just £/$1.

Hello everyone, welcome to Dan Snow's History. Here in the UK we're opening big new hospitals to cope with the large number of increased intensive care patients expected as a result of the Covid, of the Corona pandemic. When they were looking for a name for those hospitals there was really only one candidate. Britain is very proud of the role that Florence Nightingale played in global public health. She was a woman who rose to prominence as a nurse during the Crimean War, but forgotten about her career is the extraordinary impact she had after that war in improving sanitary conditions and public health of Britain. Today, the Nightingale hospitals dotted around the UK are providing life-saving work,

staffed by men and women who owe a huge amount professionally to Florence Nightingale. I'm lucky enough to have talked to Lynn MacDonald. She's both a university professor but also an activist and a former member of parliament from Toronto in Canada, which is the town my mum comes from. She's very active in propagating the memory and interpreting the work of Florence Nightingale and it was a great chance to talk to her at the height of this pandemic about what we owe to that remarkable 19th century healthcare pioneer. To listen to other episodes of this podcast without any adverts, to support everything we're trying to achieve here at History Hit or to watch hundreds of history documentaries

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by which stage hopefully the lockdown will be a memory and hopefully the curve will have flattened until such time as we don't need these remarkable nightingale institutions helping to keep us safe in the meantime everybody enjoy lynn mcdonald lynn thank you very much for coming on this show. I'm pleased to be with you. Everyone in Britain is talking about Florence Nightingale at the moment because her name has been given to this new super hospital in London, which has been built to cope with the extra cases.

Can you give me a little bit of background? Who was this person, Florence Nightingale? Well, she had a call from God, she believed, to serve and she saw that to save lives and she wanted to work but she came from a family where ladies don't work and so she wasn't allowed to. Nursing was considered the status of a kitchen maid and they certainly didn't want her to do that so she traveled and she learned a lot and she attended a Deaconess training school which didn't teach her nursing but did give her some experience in hospitals and she was then the superintendent of a very small hospital in Upper Harley Street and she knew Sidney and Elizabeth Herbert. He was the junior war minister at the time and he's the one when there was a lot of publicity about how bad the conditions were for the British Army in the Crimean War.

And that the French Army had sisters of charity and the British didn't. And so there was a public outcry and they demanded that nurses be sent. And Nightingale led that team. And Crimean War hospitals had terribly high death rates. This is why it's so very interesting to make the comparison with what we're going through now with coronavirus, because they had high death rates. But what happened there was that the death rates were brought down, and they were brought down dramatically, and they were brought down by bringing in strong sanitary conditions. And that was done by the Lord Palmerston government, a new government,

not the government that had sent the army to the Crimean War in the first place, but its replacement because of the terrible mismanagement of the war. And the sanitary commission went, and it was headed by Dr. John Sutherland, who became Nightingale's ally for the rest of her life, and a civil engineer. And they cleaned up the sewers and toilets, and got out the dead horses from the water supply. They were terrible conditions. But what's very relevant to Nightingale, between Nightingale's work and nowadays, interestingly enough, her hospital at the Crimean War was 4,000 beds. And that's what the NHS Hospital in East London in the Docklands could turn out to be.

And Nightingale was a symbol of hope. She made changes. She saved lives. And it's a very good name for the coronavirus, temporary hospitals. What's wrong with Nightingale just using knowledge that was fairly widely available at the time and just applying it to these terrible field hospitals in the Crimea? Or was she herself innovating and working these things out? It's a little bit of both. There were differences of opinion. The Army Medical Department, that is the official war office department led by doctors, they did not pay nearly enough attention to sanitary conditions. And indeed, if you look at their official report, they've got all these charts about climate, meteorological conditions, barometric pressure, temperature, humidity. Now, these are things you can't do anything about. I

mean, if it's climate, you're up against it. But Nightingale and her colleagues, that is Dr. Sutherland, and a certain number, she always had some people with her, but certainly not everybody. And they said, no, it's sanitary conditions. It's not the climate. And they actually cleaned it up. So Nightingale, I don't want to overrate what she did during the Crimean War, bringing in nursing. This is kindness, this is decency. And she was the lady with the lamp. What was she using the lamp for? Well, she actually had an attendant normally carrying it for her. So she could write last letters of dying soldiers. So she did all kinds of kind things. Now those things don't save lives. They comfort people, they don't save lives. And what I would emphasize is that what she did

that was so terribly important is after the war, she analyzed the data. I'm not a nurse or a doctor. I'm a social scientist. And I got onto her because she was a very good researcher. And she was recognized for that. And she was made the first woman fellow of the Royal Statistical Society. for that, and she was made the first woman fellow of the Royal Statistical Society. So I hope people will see some analogies with our day and say what, you know, we have in effect an experiment going on. You have different countries and different states in different areas doing different things. Some have thorough lockdowns, some started early, some had very voluntary social distancing. And let's look at the results. You see, Nightingale was a great analyser of outcomes. Look at the results and make your judgments from that.

Evidence-led policymaking, Lynn. It's a dream, dare we dream, that the future will include that. So she famously, she goes out to the Crimea, where Britain, Turkey and France are fighting against the Russian Empire in the Black Sea. What does she find when she gets out there? Well, she was actually based in Turkey. There weren't any hospitals in the Crimea itself. Presumably there was something in Sevastopol, but the Russians stayed there.

And so it was the Turkish government that gave her what was called the barrack hospital. In fact, it was a barrack. It wasn't a hospital. And it was large. It had lousy ventilation. It had no functioning toilets. They broke down. No laundry, et cetera.

Conditions were terrible. When she went, there weren't even beds and bedding. And she got those in thanks to a fund setup that she could spend that was voluntary contributions. So she certainly made some differences. To what extent they saved lives, I keep thinking it's what she did afterwards by doing that kind of analysis and doing it persuasively and convincing people that if you make the right changes, you get better results. You don't kill as many people. It's funny that we think of her as the lady with the lamp going from bed to bed, providing some sustenance for people, care for people. Is that a kind of

misogynist view of things? Are we too keen to remember her as an individual woman helping, and we're not ready enough to remember her as someone who brings about systemic change on a kind of policy level? I'm the systemic change type. I think that one should count the numbers. Nightingale was certainly a number cruncher, but that symbol of her, she did both. I mean, she did work for individuals and she patiently took down letters and some of them appeared in the press. The family was so amazed to get this comforting letter and they would send it to the local newspaper. So the individual stuff and the kindness and all of those things, they're true, they're part of her. But she also was very capable of doing research. And she didn't do it alone.

She learned. She learned a lot after the Crimean War. She worked with the top medical statistician, Dr. William Farr. And so she always had a team of people. She worked very hard, but she had good expertise because she never went to university. She never went to secondary school. Women couldn't do that then. And what, in terms of, again, lessons, I read a break at our school that you wrote, lessons of the current situation in the pandemic. I remember the story about the First World War generals spent their whole time sitting around wishing Napoleon was there to help them. If Florence Nightingale was here today, do you think that she would recognise our response? And what do you think she would do about it?

Nightingale was careful about these things. How do you know what's the best response? You don't know until you've got some data. So she's not a miracle worker. She couldn't say, this is what you should do, and you shouldn't do that. You have to do the best you can with the knowledge you have available. If there are different alternatives, you should start small and try them. And in this case, whether people wanted to make for an experiment or not, the elements of an experiment are there. Different jurisdictions have done different things. Now this happened in the Crimean War and this isn't much known, a lot's known about the Crimean War, but the comparison between what the British army did and what the French army did isn't. And that is, in the first year

of the war, the British army death rates were much higher than the French. It was the French who really wanted to go to war, and they were better equipped, so that the British really suffered. But in the second year of the war, the French death rates went up, even though there was no fighting. And that's because, you know, they were there a long time away, but the British army had made changes thanks to the Sanitary Commission and the Supply Commission. They had changed things. So here you have an experiment and you get results and you can see what the difference is. And so that's the kind of thing that I hope will be happening with the coronavirus pandemic, that in due course, people will do some really good research and say, this works better than that

and come up with some results. Nightingale wasn't a miracle worker. She wanted careful research done and she was careful in making her proposals that you start small and check it out before you generalize it. I love the description of the British Army getting quite annoyed that their huge new hospital they'd built wouldn't be full. Yes, yes. This is a lovely joke that the British Army continued to build hospitals, and this one at Netley was the largest

hospital in the world, you know, half a mile long and very imposing, looked wonderful, but it was very unsanitary, although actually some improvements were made before it was actually built. But the reforms brought in by Nightingale and Sidney Herbert as the head of a royal commission and back in government again, that they brought in changes, they improved nutrition, they improved ventilation, they improved the conditions for the British army in their barracks, and they brought the death rates down. So that the Nettley Hospital was built with the percentages expected of beds that were needed. And then, you know, if you improve conditions, you don't need so many beds because the men don't get sick. And she did joke, you know, it's not our fault if they can't fill

their beds. What does the modern nursing profession owe to Florence Nightingale? They owe a great deal and don't recognize it, especially in the UK now, and certainly in Canada and the US, it's that, oh, well, we look to the future and Florence Sidingale is the past. But she was holistic in her approach. Health promotion and disease prevention are very important, not just treating the sick after they get sick, far better to prevent it. And she was the great pioneer of something we haven't talked about so far. And that is access to quality health care, even for poor people. When you realize in her day, there was no Medicare, no NHS, all hospitals, you had to pay to get in apart from charity wards, which were not many of them. Otherwise, you had to go to the workhouse infirmary. And by far,

the vast majority of people who got sick had to go to a workhouse infirmary. Think Charles Dickens and the horrible conditions that he described. They had bed sharing, worst thing you want with infectious diseases. And they didn't have cleansing. They didn't have soap and water. They were really crummy, crummy places. And Nightingale believed that poor people should get access to quality care. And she worked for that many, many years. And the first changes began to be made. And the old workhouse infirmaries were brought up to the standards of a regular hospital. So when the NHS opened in 1948, they didn't have to go out and build new hospitals.

They could simply designate the workhouse infirmaries as regular hospitals. They've gradually been changed, and some of them were amalgamated with other hospitals, and they could go ahead. And that's very much Nightingale's work, and at least in getting it going and setting up the principles. She was the first person to set out that principle in 1866 that you see in the National Health Service of 1948. She was the first person to set out that principle in 1866 that you see in the National Health Service of 1948. She was just so much ahead of her time. Now it's called universal access to health care. It wasn't called that then, but that's what she was thinking about. Now, I can't let you go, Lynn, without asking you about policymaking, because you're very unusual.

You're both an academic, a scholar, and you sat in Canada's parliament for a long time. In fact, I think you were my sister's member of that parliament. So thank you for your service to my sister. When we're talking about evidence-led policymaking, when we're talking about the ability of Western democracies to deal with an enormous challenge like this, did your experience in politics, has it made you an optimist or has it made you pessimistic about our ability to overcome this? I am an optimist. I err on the side of optimism. And when I was in Parliament, it was a long time ago, 1980s, and I think there was less cynicism there. Certainly nobody ever said things like all politicians are crooks.

In my experience, politicians, there's a bad apple in the barrel for sure. But, you know, that happens in academe too. Let's be very sure about that. But I had the great privilege, even as a backbencher, the New Democratic Party, which is equivalent to the Labour Party, except in Canada, it's a third party. It's not formed government federally as in provinces. But I got a bill through Parliament, the Nonspokers Health Act of 1988. And it was the first legislation in the world to establish spoke-free work in public places, back when the UK was decades from even thinking about this. And it saves lives. So I feel some

kinship with Florence Nightingale. Legislation can save lives. I'm not a nurse or a doctor, but I've saved lives. That is legislation. And it was very much the work of civil society people, constituents, and the Canadian Lung Association, the Canadian Cancer Society, and people like that, that we got against the odds, against government, as a private member of that venture, got a law through that was then picked up around the world. You know, New Zealand was very early in getting it, and then the World Health Organization took it up, and the EU, etc.

The UK was one of the last places to act, but there you are. And it's evidence-based. I mean, it's still the case that the largest cause of preventable mortality in the world is smoking. 8.2 million deaths worldwide. So when I see everything that's being done on coronavirus, and I think we should be doing everything we can, I think I wish that people would look at the numbers and look at smoking. I think we're going to have a vaping crisis before long. Look at the numbers. That's Nightingale's advice. Look at the big numbers and work on the biggest issues that you can make a difference on. Well, thank you very much indeed. It's been a real treat having your input both on Florence Nightingale and what it's like to be a policymaker.

I hope your lockdown is going okay. I'm cheerful, thank you. That's all we can ask. So thank you so much. Thank you for coming on the podcast. My pleasure. Thank you. I hope you enjoyed the podcast. Just before you go, bit of a favour to ask. I totally understand if you don't want to become a subscriber

or pay me any cash money. Makes sense. But if you could just do me a favour, it's for free. Go to iTunes or wherever you get your podcast. If you give it a five-star rating and give it an absolutely glowing review, purge yourself,

give it a glowing review. I'd really appreciate that. It's tough weather. The law of the jungle out there and I need all the fire support i can get so that will boost it up the charts it's so tiresome but if you could do it i'd be very very grateful thank you