Florence Nightingale’s lessons apply to COVID-19 patient care

Florence Nightingale’s lessons apply to COVID-19 patient care
A statue of Florence Nightingale, who was born 200 years ago today. Nightingale's basic principles of sanitation and hygiene to improve health outcomes remain in use today and are vital to reducing the spread of COVID-19. (Getty Images)

An Englishwoman born 200 years ago today helped shape current efforts to prevent the spread of COVID-19 and to save the lives of those with the virus and nurse them back to health.

Named Florence after the Italian city in which she was born, she rejected her wealthy parents’ wishes and decided to become a nurse – at a time when nurses typically were poor and unskilled and the hospitals they worked in were unsanitary and often viewed as death houses.

Born on May 12, 1820, Florence Nightingale became the founder of modern nursing and forever changed the profession by bringing commonsense, life-saving care to patients that continues to this day.

A photograph of Florence Nightingale, the famed English nurse who lived from 1820 until 1910. (Courtesy of the Reynolds-Finley Historical Library, the University of Alabama at Birmingham)

Almost 60 letters she wrote reside in the University of Alabama at Birmingham’s Reynolds-Finley Historical Library. As National Nurses Week ends today with Nightingale’s 200th birthday, the Florence Nightingale Collection is a reminder of the lessons she learned and taught in the 1800s that still apply to the front-line fighters in the coronavirus pandemic.

“We’ve been using them in the school with our students to really explore some of the work that Nightingale has done,” says Doreen Harper, dean of the UAB School of Nursing. “The irony of all of this is that these letters that talk about cleanliness, sanitation and hygiene are as relevant today as they were when she started this work in the 1800s, especially as we work to fight the COVID pandemic. So we are all using Nightingale’s principles.”

UAB’s School of Nursing takes the “really crucial lessons that Nightingale documented for us” and applies them in the classroom and in practice to improve people’s health and lives, Harper says.

Peggy Balch, curator of the Reynolds-Finley library, has studied the 58 letters in the Nightingale collection and says, “There are some real parallels with Florence Nightingale’s situation and today’s COVID situation.”

Balch points to the importance of washing hands and sanitizing surfaces to prevent the spread of coronavirus, key practices that Nightingale advocated in the 1800s with dramatic results.

Reynolds-Finley’s “The Life of Florence Nightingale” notes that she is probably most famous for her work during the Crimean War (1854-56). After newspaper reports of horrific conditions in English war hospitals, she arrived with 38 nurses at the English camp in Scutari near Constantinople. Doctors didn’t want them, but as the number of wounded grew, they needed the nurses’ help. Led by Nightingale, the nurses brought cleanliness, sanitation, nutritious food and comfort to the soldiers. Within six months, the death rate for patients plummeted from 40% to 2%. In 1857, Nightingale returned to England a hero, and donations that poured in funded her reform of nursing in British hospitals and the establishment in 1860 of the Nightingale Training School, the first professional school for nurses.

Balch says Nightingale’s letters reflect her nature, values and calling to nursing. Balch cites several examples, including an 1870 letter to Madame Julie Salis-Schwabe during the Franco-Prussian War in which Nightingale writes: “People tell me to be thankful that we are ‘not in it’ – And so I am, truly thankful that our country is not in it – but that I am ‘not in it’ is the greatest regret of my life – My whole head & heart & hands are panting to be with those wretched sufferers of the Loire. And I wake every hour of the night fancying I am with them.”

A vintage engraving shows a scene from the Crimean War, 1853 to 1856, a conflict in which Russia lost to an alliance of France, Britain, the Ottoman Empire and Sardinia. The scene depicts Florence Nightingale in one of the wards of the Hospital at Scutari. (Getty Images)

Sanitation in India

For decades, Nightingale advised and corresponded with British leaders in India, most notably with Dr. Thomas Gillham Hewlett, who was sanitary commissioner and health officer of Bombay. Nightingale advised him on cholera prevention, water supply, the disposal of sewage, engineering needs and educating Indian women about sanitation.

UAB’s collection includes more than two dozen letters Nightingale wrote to Hewlett from 1867-89, as well as an 1888 letter of reference for him. In that letter, she writes: “When he began work in Bombay, the people might die of Cholera at the rate of 200 or 300 a day; & none would take any notice except to scold the Goddess of Cholera or Small-Pox. Now they will cry out, if there are 2 or 3 Deaths by Cholera.”

“She never stepped foot in India,” Harper says, “but she helped reduce the cholera epidemic in India just by helping implement the principles of sanitation and hygiene.”

Nightingale achieved those kind of results at a time disease transmission was not well understood, Balch says. “Especially now when we’re going through this and it’s becoming even more instilled in us how important this is, it makes her understanding even more revolutionary.”

Nightingale used statistics to show the dramatic impact her commonsense advice had in lowering hospital death rates. “People have called her the first statistician,” Harper says.

Harper and Balch say Nightingale’s impact extends far beyond nursing.

“Today, when we have a whole field of quality and safety in terms of reducing medical errors and getting to the best care we can provide, any time we go to a conference – and I’m talking physicians, scientists, researchers, health care administrators – they quote Nightingale. It’s not just nursing that looks to her work,” Harper says.

“Studying her life and her work, the relevance is just even more enhanced by our current situation,” Balch says. “She was a remarkable person.”

The Reynolds collection

The story of how UAB came to possess Nightingale’s letters is also remarkable. Dr. Lawrence Reynolds, born in 1889 in Ozark and a 1912 graduate of the University of Alabama, left the state to attend medical school at Johns Hopkins University in Baltimore. He began collecting historically significant books about medicine, which he continued throughout his life.

A bust of Florence Nightingale presented to her by soldiers after the Crimean War. (Courtesy of the Reynolds-Finley Historical Library, the University of Alabama at Birmingham)

While at Memorial Sloan Kettering in New York City in 1951, Reynolds bought 50 handwritten Nightingale letters from the Old Hickory Bookshop. The letters were part of his collection of 5,000 rare books and manuscripts on medicine and science that he donated to the University of Alabama School of Medicine in 1958 to establish the Reynolds Historical Library. The library predates UAB, which at the time was an extension center to Tuscaloosa’s University of Alabama. In 2014, the library became the Reynolds-Finley Historical Library after the children of pioneering geneticist Dr. Wayne H. Finley made a gift for an endowment to continue growing its medical history collections.

“I wish I could thank Dr. Reynolds,” Harper says. “He had the vision to bring these letters to Alabama even though he didn’t practice here.’’ (Reynolds spent most of his career as a radiologist in Detroit.)

“We are so fortunate to have them in our collection. He wanted them in Alabama. He was raised in Alabama. His family was from here. That’s just a great story.”

The great story continued earlier this year with the addition of eight more Nightingale letters. A retired UAB faculty member who lives in Nashville was visiting The Upper Room, a Christian ministry, during last year’s holiday season. Harper says the UAB retiree knew of The Upper Room having Nightingale letters but was told they had been put away to make room for a Nativity scene and that The Upper Room’s Christian Arts Museum was going to close in January. The retiree emailed Harper about the letters.

“When I got the email from the retired faculty member, I got up from a meeting I was in and ran to my computer and emailed the curator,” Harper says.

Five weeks later, in January, UAB finalized an agreement for The Upper Room to donate eight Nightingale letters to the library.

Harper came to UAB’s School of Nursing in 2005 and took a special interest in the letters and sharing them with the community. Lead gifts from Rick and Barrett Brock MacKay, the Harry B. and Jane H. Brock Foundation and the John and Delia Robert Charitable Trust helped make that vision a reality. University library staff have digitized the letters and all can be viewed through the UAB Digital Collections. [uab.contentdm.oclc.org]

“When I really looked at these letters and the impact, and how they can continue to influence our faculty, our students and our alumni, it’s a treasure that we have these 58 letters – not just 50 – here in Birmingham that are available to the world,” Harper says.


Related Stories