The Crimean war again - I think I might have a problem.

I was brought back to look at previous work here by a question posed to me by a GCSE pupil.

Studying medicine through time can seem remote to pupils; it is not the most gripping of subjects and so much of it can seem distant and unrelated to their lives. But when a bright enough student regurgitated 1854 as a date for Florence Nightingale's work on bringing elementary sanitation to hospitals (a contentious claim to innovation in current historical thinking but still an accepted truth at their level) he was entirely unable to connect this date to a world event that would contextualise her work.

Yes it seems the Crimean War is not only off the syllabus, it is so far off the syllabus that even events which occurred during and due to it exist in isolation of it.

I don't want to come across as the solitary cheerleader of a conflict which occurred 155 years ago so I promise my next post will have a different topic (maybe even Gin, who knows) but I do think we lack something in our education when we ignore this contextual knowledge. The only mention of the war is in passing to justify the claim that war is a factor in medical development (this being a developmental study it is essential to at least note it.) What is not covered is the crucial coming together of elements in this war that made it so important.

The circumstances of the Crimean War were such that many men were sent to hospitals not from battle wounds but minor illness. This is not an unusual state of affairs in general; illness is always a major killer in military campaigns, however the Crimean war involved long stretches of inactivity in wholly unsuitable conditions. The camps soldiers were based in were cramped, they were at the end of an extremely long supply line and the organisation was renowned as a disaster. The Crimean winter was harsh and the soldiers supplies of winter equipment were delayed. The major killers from the 18^th century were alive and well in the hospitals: Typhus, Typhoid, Cholera and Dy sentry.

The advent of rapid international communication and war correspondence brought the horrors of field hospitals home to the British public who had never conceived of them. Most especially the middle classes and their growing passion for improving the conditions of the lower sorts. Far more than in the Napoleonic Wars the middle class perceived the army as drawn from “good people” as opposed to the days when Wellington described his army as recruited from the “scum of the earth.” As this morally invested middle class saw the lower orders suffering their new-found political power manifested in pressure for government intervention.

And it was government intervention that really made Nightingale's reputation. She was not the great innovator of hygiene that we teach and I feel we do public health an injustice to attribute it to her. while certainly she campaigned for better conditions in terms of diet, lighting and comfort, it was a government commission which arrived not long after her that really made a difference. The sewer system at Scolari was the source of much of the ills which killed so many soldiers; the commission had these sewers cleared and flushed clean which resulted in a dramatic decline in deaths. Nightingale documented the effects of this act and it was her detailed note taking which proved the benefits of improved hygiene not her own innovations. This co-incided with John Snow's 1854 report on Cholera in London to provide clear evidence for the Government's involvement in public health.

Without knowing the context; the terrible conditions of the Crimean war, the shift in public attitude towards the army and the moral demand for improvement, or the impact fighting a war the other side of Europe which could be read about increasingly up to date, our pupils cannot really demonstrate an understanding of Nightingale's actions.