The following blog post was contributed by Isabel Luce, who is the Museum of Health Care’s 2018 Margaret Angus Research Fellow. Isabel has a BA in Canadian Studies and Art History from McGill University, and an MA in Art History and Curatorial Studies, and is working towards completing her PhD in Art History at Queen’s University. This is Isabel’s third blog post in a series she will be writing throughout the summer. Special thanks to Trustees of the Estate of Larry Gibson, Graeme Fraser and Jay Rayner, for their generous support of this fellowship.
Considered by many as the founder of modern nursing, British social reformer Florence Nightingale (1820-1910) was one of the most well-known female voices on health care in the 19th century. In this blog entry, I outline what Florence Nightingale believed was the most important consideration of nursing – the ventilation and good air of a patient’s room – and will explore how this advice recurs and develops in the ensuing forty years in home advice manuals.
An Introduction to Florence Nightingale
Nightingale was born into an affluent British family and from a young age she received what she called “calls from God” that encouraged her to pursue a life devoted to caring for others. (1) Despite her family’s protests, she began to teach herself the science of nursing at a time when it was frowned upon for a woman of her upper class social status to take on such a position. During the Crimean War (1853-1856), Nightingale, along with 38 other volunteer nurses, went to Crimea to assist the medical staff in the war effort. While there, Nightingale realized that many of the soldiers were dying from fast-spreading illnesses, more so than the wounds they received in battle. She began to implement mandatory handwashing and other hygienic procedures. News of her innovative work soon spread widely, and Nightingale was given the nickname “The Lady with the Lamp” by the popular press due to stories of her making rounds of the sick and injured throughout the darkest hours of the night with an oil lamp in hand.
Upon returning to England after the war, Nightingale opened the first nursing school in London, an act that would lead to nursing becoming increasingly considered as a respectable profession for a woman to choose. Her saintly reputation during the war effort likely assisted in her success. Not only did Nightingale devote her life to teaching, but also to sharing the tenets of good nursing to the general public. She wrote extensively on medical topics throughout her life, using simple English and incorporating graphics into her text to make the knowledge even more accessible to the layman. Her writings clearly explain her belief that illness and disease originate from bad air and dirt, which was the conclusion she came to from her personal experiences in the unsanitary Crimean war hospitals. In order to improve the health of her patients, one must have hygienic rooms and fresh air. At the same time, chemists and physicians were working towards a deeper understanding of how microorganisms were the cause of disease and of the role of airborne dust and dirt in the spread of these illnesses (as can be seen in Louis Pasteur’s 1861 treatise, a precursor to the germ theory of disease that would be more commonly accepted by the 1870s). (2) Nightingale’s views reflect the mid-19th-century belief of unhealthy organic miasmas: the idea that particles in the air may carry disease and need to be removed before they contaminate those exposed to this air.
Ventilation and Warming according to Nightingale
In 1859, Nightingale wrote her influential book Notes on Nursing. It was used in the curriculum at her own school, but was primarily intended for wide use by the public as the preface explains, “every woman, or at least almost every woman, in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid,–in other words, every woman is a nurse.” (3) This emphasized that everyone should have general medical knowledge as so many simple steps can be taken within the home to avoid illnesses progressing further and to allow the body to have a chance to fight off infection. Nightingale goes on to provide an in-depth list of tips so that every woman could have the ability to educate herself on how to nurse, covering topics as far-ranging as the health of houses, food, personal cleanliness, light, ventilation, and more. These categories are ones that would be repeated in the ensuing genre of home advice literature, and so it is intriguing that Nightingale’s book – a textbook on nursing – may in fact be one of the precursors to the genre of home advice literature.
According to Nightingale, the first canon of nursing was to “keep the air the patient breathes as pure as the external air, without chilling him.” (4) This is the first aspect a nurse should attend to above all else, and yet the freshness of the air is often one of the most overlooked. Few consider what happens when you open the door to a patient’s room, be it in the hospital or in the home. As Nightingale warns, the air that is let in might come “from a hall, always unaired, always full of the fumes of gas, dinner, of various kinds of mustiness; from an underground kitchen, sink, washhouse, water-closet, or even, as I myself have had sorrowful experience, from open sewers, loaded with filth; and with this the patient’s room or ward is aired, as it is called—poisoned, it should rather be said.” (5) Stale, unventilated air is “stagnant, musty, and corrupt as it can by possibility be made [and] [i]t is quite ripe to breed small-pox, scarlet-fever, diphtheria, or anything else you please.” Nightingale was concerned about the effect of opening doors to these stale hallways, unused rooms or empty courtyards by unthinking individuals; they inadvertently expose their families to the diseases that hide in this bad air.
But would a Victorian woman combat this silent killer at her door? Nightingale believed that the solution was simple: a “proper supply of windows, and a proper supply of fuel in open fire-places” was all one need, and to “never be afraid of open windows” because as long as the patient was kept warm in bed with hot water bottles and blankets, the well-ventilated air would help them recover faster than most medicines. (6)
Ventilation in Other Sources
The critical importance of ventilation becomes a common theme over the next forty years in home advice manual literature, likely due to Nightingale’s far-reaching influence. Isabella Beeton echoed Nightingale’s advice in her 1861 book Mrs. Beeton’s Book of Household Management, saying that the need for fresh air can be easily met with “proper windows, open fireplaces, and a supply of fuel, the room may be as fresh as it is outside, and kept at a temperature suitable for a patient’s state.” (6) Beeton gives more detail, explaining that windows need to be opened from above in order to avoid draughts as,
“Cool air admitted beneath the patient’s head chills the lower strata and the floor. The careful nurse will keep the door shut when the window is open; she will also take care that the patient is not placed between the door and the open window, nor between the open fireplace and the window. If confined to bed, she will see that the bed is placed in a thoroughly ventilated part of the room, but out of the current of air which is produced by the momentary opening of doors, as well as out of the line of draught between the window and the open chimney, and that the temperature of the room is kept about 64˚. Where it is necessary to admit air by the door, the windows should be closed; but there are few circumstances in which good air can be obtained through the chamber-door; through it, on the contrary, the gases generated in the lower parts of the house are likely drawn into the invalid chamber.” (7)
Good ventilation, according to Beeton, as well as a simple diet are especially important in cases of infectious illnesses like typhus, chicken pox or measles, as it was commonly believed that these illnesses would be even more potent if they were concentrated in confined spaces with little ventilation. Once the illness was let out it “settles upon the clothes of the attendants and visitors, especially where they are of wool, and is frequently communicated to other families in this manner.” (8) Maintaining the temperature of the sick-room as fresh and warm, as Nightingale encouraged, was also important to Beeton, and she encourages her readers to “tak[e] care that the fire burns clear, and gives out no smoke into the room; that the room is perfectly clean, wiped over with a damp cloth every day, is boarded; and swept, after sprinkling with damp tea-leaves, or other aromatic leaves, if carpeted; that all utensils are emptied and cleaned as soon as used, and not once in four-and-twenty hours, as is sometimes done.” (9) Emma Hewitt also writes, the body often produces less heat during illness so it is important to have extra blankets, hot bricks, or hot water bottles nearby so they can be put into the bed to warm up the patient when you see any indication of chilliness.
Even the smell of a sick room should be taken into account, according to these advice books, as the bad smells were indicative of bad air and so using fragrant leaves, flowers or burning pastilles allowed nurses to combat the smell. Bad air can also come from dirty water, and so the slop-pail used to clean floors should never be brought into the sick room, and maids should never be made into nurses although nurses often feel compelled to take on the task of maids as Nightingale writes: “I have seen surgical sisters, women whose hands were worth to them two or three guineas a week, down on their knees, scouring a room or hut, because they thought it was not fit for their patients: these women had the true nurse spirit.” (10)
Other home advice authors, like Shirley Forster Murphy in Our Homes and How to Make Them Healthy (1883), devoted large sections of their books to the importance of warming and ventilation. Murphy’s book contains 15 chapters devoted to this subject, incorporating the advice of doctors like Dr. Douglas Galton to add credibility to her claims. Her book goes into much more detail than the aforementioned ones as the composition of the air (the presence of carbonic acid, carbonic oxide, smoke and fog, the ozone) is explained at the beginning, followed by how air deteriorates in confined spaces, the effect the density of a city’s population may have on the quality of air, the way the air moves, the importance of ventilators, and so on. (11) This source as well as the others mentioned in this blog post show the complexity of discussions of the transmission of diseases that were being proven through scientific experiments at the same moment as they were being promoted to those who could make the most use of the new knowledge: the women of the home. These books made the most fundamental aspects of scholarly medical textbooks accessible to those who could effect the largest amount of change. It was the woman of the house who would be able to prevent illness spreading and worsening, and it could be done by something as simple as opening a window and ensuring the patient received fresh air.
(1) Barbara M. Dossey, “Florence Nightingale: A 19th-Century Mystic,” Journal of Holistic Nursing, American Holistic Nurses Association, 3, no. 1 (March 2010): 10.
(2) Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass.: Harvard University Press, 1998), 31.
(3) Florence Nightingale, Notes on Nursing: What It Is, And What It Is Not (London: Harrison, 1860), Preface.
(6) Isabella Beeton, The Book of Household Management (London: Ward, Lock and Co., 1880), this version was accessed from – Urbana, Illinois: Project Gutenburg: http://www.gutenberg.org/ebooks/10136, 2417.
(7) Ibid, 2418.
(8) Ibid, 2421.
(10) Nightingale, Notes on Nursing, Preface.
(11) Shirley Forster Murphy, Our Homes and How To Make Them Healthy (London: Cassel & Company, 1883)