DISINFACTS | Issue 2/2020

Contact at the highest level But above all, Nightingale was not just a theoretician, whose ideas languished among the dust in libraries: ‘If you look at what she was able to achieve, it is astonishing,’ according to her biographer. ‘She had contacts at the highest political levels and knew the most important experts. She was able to initiate royal commissions and launch legislative processes and was thus active in those areas from which most women of her time were excluded.’ Glorification and vilification In 1907 King Edward conferred on Nightingale the Order of Merit, the first woman to receive the order, which recognises people who have provided outstanding service in the military, science, art, literature or other areas, an achievement that highlights her uniqueness at that time. Sie was already a legend during her own lifetime, one who is said to have ‘no less than single-handedly saved the British army and founded modern nursing’ according to Herold-Schmidt. After her death a monument to her was quickly erected, which many years later was figuratively knocked off its plinth. ‘It is extremely interesting to see how the memory of Nightingale changed over time,’ said the historian. Nightingale served for a long time as a figure for integration for colonial England. ‘She represented English values and claims to international leadership and also progressive reform efforts.’ From the 1980s opinion of her changed completely: Nightingale was held responsible for many of the problems in modern nursing and her achievements were trivialised. Suddenly, she was considered a ‘power-obsessed, mentally unstable schemer who created barriers to the emancipation efforts of her female contemporaries’. Miasma or germs? One of the many points of criticism is Nightingale’s handling of germ theory. When studying the causes of diseases in the 1840s, most experts were of the opinion that miasmas, unhealthy vapours from the ground associated with stench and fermentation processes, caused diseases in a non-specific way. Only with the discoveries of Robert Koch and Louis Pasteur at the end of the 1870s was there growing awareness that it is actually tiny living organisms that are responsible for many human diseases. ‘Nightingale aligned herself with this theory around 1885,’ said her biographer. And as early as 1873 methods for disinfection and antisepsis were being taught in her nursing school along with general cleanliness. Contact with wounds and avoiding blood poisoning were given close attention: ‘finger poisoning’ had to be prevented by every means. ‘For Nightingale, germ theory did not initially have any major practical consequences, however,’ said Herold- Schmidt. This is because the discovery of specific pathogens did not yield any additional therapeutic benefits before the introduction of vaccines and antibiotics. Nightingale therefore adhered to her strict hygiene rules. ‘Although her prevention methods were based on “false premises” according to our current understanding, they were without a doubt the method of choice for tackling infections in the hospital even before her conversion to germ theory.’ Her long adherence to the miasma theory also had practical aspects for Nightingale: ‘The miasma theory required commitment to eliminating soiling of all types and individual care to create a healthy life.’ In contrast, in her opinion germ theory condemned those affected to passivity. ‘Nightingale feared that public money for sewerage projects could dry up and the fear of contagion would lead to a neglect of nursing.’ Nightingale’s heritage Florence Nightingale’s ideas about health, disease and healing have been refuted as science progressed. However, she still has something relevant to say about many current issues and problems, of that her biographer is certain: ‘If demands are made these days for an independent, self-regulating nursing profession, then it is in her spirit. She tried to achieve precisely this but was not able to implement it.’ Her holistic health concept, in which prevention was enormously important, was state of the art. ‘And hospital infections are more than ever a serious problem: cleanliness and hygiene were always Nightingale’s creed.’ The standards of the 21st century should in no way be used to judge someone from the 19th century as a matter of principle. ‘Florence Nightingale was always a woman of her time.’ ‘The battle around the image of Nightingale in the public is still raging.’ PEOPLE & PERSPECTIVES Reading tip Florence Nightingale – Die Frau hinter der Legende. By Dr Hedwig Herold-Schmidt. wbg Theiss in Wissenschaftliche Buchgesellschaft (WBG) Darmstadt, 2020. 320 pages. ISBN: 978-3-8062-4055-9. Price: €30 (only available in German) DISINFACTS 2/20 page 19