The Logos Scripture · The Book of Nightingale

On What I Counted at Scutari

The Book of Nightingale 1 · Written by herself, from Notes on Matters Affecting the Health of the British Army, Notes on Nursing, and the letters

Florence Nightingale, born 1820 at Florence in Italy, from which she was named, died 1910 in London, aged ninety. She came from a wealthy English family. When the Crimean War began in 1854 she took thirty-eight nurses to the military hospital at Scutari. There she instituted a form for recording deaths, had it filled in daily, and worked out that most of the deaths in the hospital came from preventable disease — dysentery, typhus, cholera — rather than from wounds; in the worst month of that winter, four hundred and twenty-seven of every thousand men in hospital died. She returned in 1856 with a fever, generally now thought to have been brucellosis, from which she never recovered, and for decades could barely leave her rooms. In 1858 she submitted Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, containing the polar-area diagram later called the rose diagram: twelve wedges for twelve months, area standing for the number of deaths, and two colours dividing wounds from disease. In that same year she became the first woman elected to the Royal Statistical Society. In 1859 she published Notes on Nursing. For the decades following she drove army sanitary reform, the sanitation of the Indian barracks, and the reform of workhouse infirmaries from her bed, and founded a school of nursing. She wrote some fourteen thousand letters. This volume rests on what she wrote herself: those works and the letters. The figures of chapter one and the diagram of chapter two are in the 1858 report. To understand God’s thoughts we must study statistics, quoted in chapter five, is her own sentence. What this volume brings is the answer to the question the fourth chapter of the book of Semmelweis leaves open. Semmelweis held evidence that pointed at its hearers, and for that reason it could not get through (cf. The Book of Semmelweis 4.13). Nightingale’s evidence pointed at the War Office — the same position — and she succeeded. Chapters two and three are how. First: the table sent up did nothing, because the men reading it would not do the working-through in their heads; so she made it visible at a glance — if a thing is true, making it visible at a glance is not a trick. Second: she knew whom the figures pointed at, and she did not shout. Verses 3.7 and 3.8 give the reason: to grant it is to grant some thousands of deaths, and to push it away costs one sentence, this woman exaggerates; had she shouted she would have paved the cheaper road for them. Verse 3.14 is where this volume meets the other — whoever wants to be acknowledged will shout, whoever wants the thing done does not (cf. The Book of Semmelweis 4.19). Chapter four carries something else: she does not pretend the illness was good, and does not deny it took years from her; she says only that a thing which blocks you will sometimes force you into a more useful way of working. The Order records chapter five and holds it to be the weightiest in the volume, and a singular case in this scripture. The canon holds many devout men — Newton, Faraday, Maxwell, Semmelweis, Dürer, Washington — and takes them because their arguments do not close on divine will: the two rooms (cf. The Book of Newton 4). Nightingale is not like that. She has one room. She believed God acts by law, concluded therefore that reading the law is the service, and that the law is visible only in numbers. So her belief did not excuse her from counting; it obliged her to count. Verse 5.11 is that: prayer cannot stand in for counting, and when you have prayed you must still go and count. It agrees with the Prologue, that God is the law (cf. The Prologue 1.7), and runs the same way as Spinoza’s God, who has no will, no purpose, and does not hear prayers (cf. The Book of Spinoza). The Order holds that a person may pray and must act by reason; Nightingale is the one in this scripture who made those a single act.

1.1In 1854 I took thirty-eight nurses to Scutari, a military hospital across the water from Constantinople.
1.2What the place was like when I arrived I do not set down. Nobody would believe it, and setting it down does no good.
1.3The first thing I did was not to treat anyone. It was to look for the registers.
1.4What I wanted was: how many died, on what day, and of what.
1.5Nobody then was keeping that seriously. Some kept it and kept it badly; some kept nothing.
1.6I made a form and made them fill it in, day by day.
1.7I filled it in too. When the night round was done I sat down and reckoned.
1.8After somewhat more than a year the figure came out.
1.9Of the soldiers who died in that hospital, the greater part did not die of sword or shot.
1.10They died of dysentery, of typhus, of cholera — died in the room we had put them into.
1.11Stop at this sentence: it was not the field that killed them. It was the hospital.
1.12In the worst month of that winter, of every thousand soldiers in hospital, four hundred and twenty-seven died.
1.13And in the same season, the unwounded men still in camp died at a lower rate than the men in hospital.
1.14Which is to say: to send a wounded man into that hospital was to reduce his chance of living.
1.15That sentence is not something I thought up. That sentence came out of the registers. (cf. The Book of Chekhov 4.14)
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