Florence Nightingale and Hospital Reform: Collected Works of Florence Nightingale, Volume 16

Civil Hospitals: Letters and Notes

Civil Hospitals: Letters and Notes Top: Johns Hopkins University Hospital, Baltimore, Maryland, a model American pavilion hospital. Bottom: Royal Victoria Hospital, Montreal, designed by Henry Saxon Snell, with input from Nightingale. 496 / Civil Hospitals: Letters and Notes N ightingale’s need for data on civil hospitals is evident in her work on military hospitals, undertaken upon her return from the Crimean War. The same laws affecting health or disease held in both kinds of hospital; there were more civil hospitals than military; and peacetime conditions were the norm, war the exception. Part of the case she made on army hospitals in her Crimean War analyses relied on comparisons with civil hospital data. Then, soon after her return from that war she began to receive requests for assistance on civil hospital plans, which she continued to receive into old age. Unlike military hospitals, there was a great diversity of types of civil hospital for Nightingale to consider, from general hospitals to convalescent and cottage hospitals, workhouse infirmaries and lying-in institutions . There was no system of hospitals in her day; the National Health Service was not even a thought; and the regular civil hospitals were independently managed by their particular boards. Decision makers ranged from reform-minded doctors to hospital committees, Poor Law guardians, architects and concerned citizens whereas, in the military , control largely lay with the Army Medical Department, sometimes the (civilian) War Office or (army command) Horse Guards. Where there is sufficient material on a particular hospital, I have grouped it together and provided an introduction. In-between items are simply reported in chronological order. The last note available by Nightingale dates to 1901, the last action by her to 1908. Both of these, tellingly, concern her first hospital, the Establishment for Gentlewomen during Illness in Harley St. Topics of the correspondence and publications range from the basic principles of the pavilion model, issues of site and materials to statistics to track results. Nightingale focused on design to facilitate patient care and efficient nursing from early on to late in her career. Concerns about specialized hospitals, especially children’s hospitals / 497 and children’s wards, again are present from early to late in the correspondence . There are sections on convalescent and cottage hospitals. Gathering and maintaining statistics to enable effective decision making continue to be important in this section, and Nightingale sought advice from experts as to how to improve them. For example, she asked Dr Farr in 1861 to go over the statistics for St Thomas’ Hospital . Both she and James Paget at St Bartholomew’s wanted his assessment , obviously for the purpose of making them more useful (see p 574 below). Broader health conditions in cities, towns and rural areas emerge periodically, although the main subject is general, acute care hospitals in major cities. There are several short articles, first published in the reliable Builder (one on preventible disease and three on the site for St Thomas’ Hospital ), and a substantial paper, ‘‘Hospital Statistics and Hospital Plans,’’ written for the National Association for the Promotion of Social Science. Whistle blowing was another Nightingale activity, and since she held no paid position and needed none, she had nothing to lose. She was well aware that persons who complained could easily forfeit promotion or even lose their jobs. To put pressure on the Winchester Infirmary to build a new hospital at a healthier site she passed on the report of deaths there to the Registrar-General and to the ‘‘most eminent surgeons’’ of London. The plan was for the Registrar-General to call for a formal report, which would be public and damning. Nightingale sometimes lost her battles on hospitals. She gave advice on plans and met with architects often to no avail. Thomas Bellamy , architect of King’s College Hospital, went over his ‘‘execrable’’ plans with her (see p 588 below), but since every subsequent reference to those plans is negative, we can infer that her advice was not taken. She strongly urged that a new Manchester Royal Infirmary be built out of the city, but the hospital authorities instead chose to expand on the downtown site already occupied. She also at times gave advice on hospitals that were never built, for unrelated reasons: the Montreal General Hospital is a prime example. Much of the correspondence is missing, a fact known from letters to her, to others she consulted, and notes she made about the hospital...