Lessons from the Life of Florence Nightingale

"It may seem a strange principle to enunciate," wrote Miss Nightingale in 1863, "as the very first requirement in a hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle, because the actual mortality in hospitals, especially in those of large crowded cities is very much higher than any calculation founded on the mortality of the same class of diseases among patients out of hospitals would lead us to expect."

At the time Miss Nightingale returned from the Crimea, the death rate in hospitals was lamentably high, and it was but natural that she should turn her attention to remedying such conditions, or at least to call attention to them. In 1858 her book, "Notes on Hospitals," was issued. A noted man in acknowledging receipt of a copy stated that it appeared to him to be the most valuable contribution to sanitary science in application to medical institutions, that he had ever seen. In this book we find her calling attention to overcrowding, lack of drainage under hospitals, to ventilation, to the necessity of having non-absorbent floors and walls, to the desirability of iron beds, hair mattresses, and glass or earthen ware cups, instead of tin -- also to needed improvements in hospital kitchens and laundries, to the curative effects of light -- all of which ideas are today regarded as essentials in hospitals, but which were then years in advance of general practice. It is easy to point out defects -- not always so easy to produce practical plans for correcting them, but Miss Nightingale not only called attention to the defects but at the same time showed how to remedy them. In the second edition of the book she enumerated "Sixteen Sanitary Defects in the Construction of Hospital Wards" -- accompanying each statement with definite plans for correcting the defect. The publication of this little book on hospitals brought to her numerous requests for consultation regarding the construction of new hospitals which were being planned and more than a dozen hospitals constructed, soon after that time, had the benefit of her advice and detailed consideration of the architect's plans.