men to use. In this filth lay the men’s food—Miss
Nightingale saw the skinned carcass of a sheep lie in a
ward all night...the stench from the hospital could
be smelled outsidethe walls (Woodham-Smith, 1983).Upon her arrival in the Crimea, the immediate
priority of Nightingale and her small band of
nurses was not in the sphere of medical or surgical
nursing as currently known; rather, their order
of business was domestic management. This is
evidenced in the following exchange between
Nightingale and one of her party as they ap-
proached Constantinople: “Oh, Miss Nightingale,
when we land don’t let there be any red-tape delays,
let us get straight to nursing the poor fellows!”
Nightingale’s reply: “The strongest will be wanted
at the wash tub” (Cook, 1913; Dolan, 1971).
Although the bulk of this work continued to be
done by orderlies after Nightingale’s arrival (with
the laundry farmed out to the soldiers’ wives), it
was accomplished under Nightingale’s eagle eye:
“She insisted on the huge wooden tubs in the wards
being emptied, standing [obstinately] by the side of
each one, sometimes for an hour at a time, never
scolding, never raising her voice, until the orderlies
gave way and the tub was emptied” (Cook, 1913;
Summers, 1988; Woodham-Smith, 1983).
Nightingale set up her own extra “diet kitchen.”
Small portions, helpings of such things as arrow-
root, port wine, lemonade, rice pudding, jelly, and
beef tea, whose purpose was to tempt and revive the
appetite, were provided to the men. It was therefore
a logical sequence from cooking to feeding, from
administering food to administering medicines.
Because no antidote to infection existed at this
time, the provision—by Nightingale and her
nurses—of cleanliness, order, encouragement to
eat, feeding, clean bed linen, clean bodies, and clean
wards, was essential to recovery (Summers, 1988).
Mortality rates at the Barrack Hospital in
Scutari fell. In February, at Nightingale’s insistence,
the prime minister had sent to the Crimea a sani-
tary commission to investigate the high mortality
rates. Beginning their work in March, they de-
scribed the conditions at the Barrack Hospital as
“murderous.” Setting to work immediately, they
opened the channel through which the water sup-
plying the hospital flowed, where a dead horse was
found. The commission cleared “556 handcarts and
large baskets full of rubbish...24 dead animals and
2 dead horses buried.” In addition, they flushed and
44 SECTION II Evolution of Nursing Theory: Essential Influences
cleansed sewers, limewashed walls, tore out shelves
that harbored rats, and got rid of vermin. The com-
mission, Nightingale said, “saved the British Army.”
Miss Nightingale’s anticontagionism was sealed as
the mortality rates began showing dramatic de-
clines (Rosenberg, 1979).
Figure 5–3 illustrates Nightingale’s own hand-
drawn “coxcombs” (as they were referred to), as
Nightingale, being always aware of the necessity of
documenting outcomes of care, kept copious
records of all sorts (Cook, 1913; Rosenberg, 1979;
Woodham-Smith, 1983).
Florence Nightingale possessed moral authority,
so firm because it was grounded in caring and was
in a larger mission that came from her spirituality.
For Miss Nightingale, spirituality was a much
broader, more unitive concept than that of religion.
Her spirituality involved the sense of a presence
higher than human presence, the divine intelli-
gence that creates, sustains, and organizes the uni-
verse, and an awareness of our inner connection to
this higher reality. Through this inner connection
flows creative endeavors and insight, a sense of pur-
pose and direction. For Miss Nightingale, spiritual-
ity was intrinsic to human nature and was the
deepest, most potent resource for healing.
Nightingale was to write in Suggestions for Thought
(Calabria & Macrae, 1994, p. 58) that “human con-
sciousness is tending to become what God’s
consciousness is—to become One with the con-
sciousness of God.” This progression of conscious-
ness to unity with the divine was an evolutionary
view and not typical of either the Anglican or
Unitarian views of the time (Rosenberg, 1979;FIGURE 5–3 Diagram by Florence Nightingale showing declin-
ing mortality rates.From Cohen, I. B. (1981). Florence Nightingale:
The passionate statistician. Scientific American, 250(3): 128–137.