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The inevitability of rampant deaths in medical institutions was a soberly accepted fact in the 1840s and 1850s. This disturbing reality began to change only after it was smothered under a mountain of facts, data and new ideas from hygienic and sanitation activists—most notably Florence Nightingale.

Shining Light (First part of this two-part series)

The most influential period of Florence Nightingale's career often has been her most overlooked. The Lady with the Lamp, who worked at correcting the horrific conditions at army hospitals near the front of the Crimean War, devoted her post-war years bringing changes to health care at home in England and abroad-raising the standards for both hospitals and for nursing.

Hospitals in Victorian England were no place for patients. Especially for those who were hoping to get well.

Operated strictly for indigent patients (the well-to-do received home-based care), hospitals were overcrowded and filthy lairs of disease and neglect where one in seven patients died. It was even worse for the larger metropolitan facilities in London, where statistics showed those with 300-plus beds were suffering one death per 2.4 patients-despite the prestige of employing the most well-respected medical staffs and physicians in the country, said medical historian Robert Martensen, MD, Ph.D.

"The term itself for people getting sick in hospitals was called 'hospitalism'-this notion that the hospital, the building itself, would make one ill," said Martensen, chair of humanities and ethics in medicine at Tulane University School of Public Health and Tropical Medicine in New Orleans.

The inevitability of rampant deaths in medical institutions was a soberly accepted fact in the 1840s and 1850s. This disturbing reality began to change only after it was smothered under a mountain of facts, data and new ideas from hygienic and sanitation activists-most notably Florence Nightingale.

An 1857 Royal Commission on sanitation, studying the high number of Crimean War deaths between 1854 and 1856, came to the conclusion that nearly 16,000 soldiers died needlessly from organizational mismanagement, neglect and unsanitary conditions at army hospitals. According to historians, the prime evidence was a ground-breaking report written by Nightingale herself, one that was filled with comparative numbers, statistical analysis and carefully drawn pie charts that rarely had been seen in a public policy document. "Our soldiers enlist to death in the barracks," Nightingale concluded in her nearly 1,000-page report.

Scholars say her largely uncredited contribution to that commission (women could not serve on such public boards) was the starting point for foundational changes in military medical sanitation, training and data collection.

Her ideas also were adopted for civilian hospitals, according to researchers, and helped foment a surge in public health standards in England and across the globe, especially for the poor.

The legend

Nightingale returned from the Crimean War a hero, the "Lady with the Lamp," who had saved and nurtured British soldiers near the frontlines of an unpopular war. The name was coined because she carried a lamp as she checked on sick soldiers during the night.

Had she done nothing else, her picture still would have adorned British currency a century later. But Nightingale's incredible career had only begun, and her greatest accomplishments were yet to be established.

Each fall, incoming students at Tulane Medical School arrive in Martensen's history of surgery class to learn from the deep repository of techniques, theories and practices collected during the past 500 years. Martensen, who has degrees from Harvard, Dartmouth and the University of California, San Francisco, takes them on a tour through the 16th century natural philosophists to the 19th century stewards who applied the scientific model to medicine.

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