FOR BLOOMING IN WARDS¹—NIGHTINGALE

In May 1857 a Commission to study the whole question of the army medical service began to sit. The price was high. Florence Nightingale was doing this grueling work because it was vital, not because she had chosen it. She had changed. Now she was more brilliant in argument than ever, more efficient, more knowledgeable², more persistent³ and penetrating⁴ in her reasoning, scrupulously⁵ just, mathematically accurate—but she was pushing herself to the very limits of her capacity at the expense of all joy.

That summer of 1857 was a nightmare for Florence—not only was she working day and night to instruct the politicians sitting on the Commission, she was writing her own confidential⁶ report about her experiences. All this while Parthe and Mama lay about on sofas, telling each other not to get exhausted⁷ arranging flowers.

It took Florence only six months to complete her own one-thousand-page Confidential Report, Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army. It was an incredibly clear, deeply-considered volume. Every single thing she had learned from t Crimea was there—every statement she made was backed by hard evidence.

Florence Nightingale was basically arguing for prevention rather than cure. It was a new idea then and many politicians and army medical men felt it was revolutionary and positively⁸ cranky. They grimly opposed Florence and her allies.

She was forced to prove that the soldiers were dying because of their basic living conditions. She had inspected dozens of hospitals and barracks and now exposed them as damp, filthy⁹ and unventilated, with dirty drains and unventilated, with dirty drains and infected water supplies. She showed that the soldiers’ diet was poor. She collected statistics which proved that the death rate for young soldiers in peace time was double that of the normal population.

She showed that, though the army took only the fittest young men, every year 1,500 were killed by neglect, poor food and disease. She declared “Our soldiers enlist¹⁰ to death in the barracks”, and this became the battle cry of her supporters.

The public, too, was on her side. The more the anti-reformers dragged their feet, the greater the reform pressure became.

Florence did not win an outright¹¹ victory against her opponents, but many changes came through. Soon some barracks were rebuilt and within three years the death rate would halve¹².

The intense work on the Commission was now over, but Florence was to continue studying, planning and pressing for army medical reform for the next thirty years.

People now began to demand that she apply her knowledge to civilian¹³ hospitals, which she found to be “just as bad or worse” than military hospitals. In 1859 she published a book called Notes on Hospitals. It showed the world why people feared to be taken into hospitals and how matters could be remedied.

Florence set forth¹⁴ the then revolutionary theory that simply by improving the construction and physical maintenance, hospital deaths could be greatly reduced. More windows, better ventilation, improved drainage, less cramped¹⁵ conditions, and regular scrubbing of the floors, walls and bed frames were basic measures that every hospital could take.

Florence soon became an expert on the building of hospitals and all over the world hospitals were established according to her specifications¹⁶. She wrote hundreds and hundreds of letters from her sofa in London inquiring about sinks and saucepans, locks and laundry rooms. No detail was too small for her considered attention. She worked out ideas for the most efficient way to distribute clean linen¹⁷, the best method of keeping food hot, the correct number of inches between beds. She intended to change the administration of hospitals from top to toe. Lives depended upon detail.

Florence Nightingale succeeded. All over the world Nightingale-style hospitals would be built. And Florence would continue to advise on hospital plans for over forty years. Today’s hospitals with their flowers and bright, clean and cheerful wards are a direct result of her work.

1857年5月，一个研究军队医务全项问题的委员会成立了。为此付出的代价是巨大的。这项辛劳的工作交给了弗洛伦斯·南丁格尔，并不是因为她主动请缨，而是这任务至关重要。她开始变了。变得比以往更能言善辩，更注重实效，更有见地，在论理上也更加坚定和深刻。她作风严谨，精益求精——这所有一切是她用牺牲所有的娱乐换来的。

1857年的夏天对弗洛伦斯来说是一场梦魇——她不仅要夜以继日地说服参与委员会工作的政客们，还要就她的个人经历撰写述职报告。而与此同时帕尔丝和母亲却靠在沙发上，相互提醒着插花不要插得太累。

弗洛伦斯只用了六个月的时间就独自完成了长达一千页的《关于英国军队保健、效率和医院管理事项的纪要》的机密报告。其阐述之清晰，考虑之深入令人难以置信。她从克里米亚学到的一点一滴都跃然纸上——每项陈述都论据充分。

弗洛伦斯·南丁格尔的基本主张是防患于未然。这在当时是标新立异的，许多政客和军医都觉得这过于出格同时又是稀奇古怪的。他们顽固地反对弗洛伦斯和她的支持者们。

她不得不尽力去证实士兵们的基本生活条件是造成他们死亡的原因。她调查了几十家医院和兵营从而发现这些地方潮湿、污秽而且通风不畅，排水管污浊并且供水系统受到污染。她指出病号饭欠佳。她根据收集的统计数据证明在和平时期年轻士兵的死亡率是普通人的两倍。

她证实了尽管军队只招募最健康的年轻人，但每年仍有1500人死于疏忽大意、缺乏营养的食物和疾病。她大声疾呼道“我们的士兵在军营里被死亡招募而去”，这成为她的支持者们的斗争呼声。

公众们也站在了她的一边。反对改革的保守派越是拖后腿，改革的压力就越大。

尽管弗洛伦斯没有取得对反对派的彻底胜利，但确已出现了许多变化。有些兵营被改建，三年内死亡率从预计的减少一半。

至此委员会的紧张工作告一段落，但弗洛伦斯仍要继续研究，计划及督促今后三十年的军队医疗改革。

人们现在开始希望她能将自己的学识用在民用医院方面，这些医院的情况在她看来和军队医院“一样糟，甚至更糟”。1859年她出了一本叫做《医院纪要》的书。该书向全世界揭示了人们害怕去医院的原因以及如何改良。

弗洛伦斯提出了在当时是颇为革命的理论即只要改进并能维护医院设施，医院的死亡率就会大幅降低。增开窗户，加大通风，改善排污，减少拥挤及定期刷洗地面、墙壁和床架是所有医院应采取的基本措施。

弗洛伦斯不久就成了医院设施方面的专家，全世界的医院都以她制定的细则进行设计。她坐在伦敦家里的沙发上，写了成百上千封的信件询问有关洗涤槽和平底锅、门锁和洗衣房的情况。对她来说事无巨细都予以细致入微的关注。她想出办法，最有效地来发放干净的被褥，最好地保温食物的方法，床与床之间最佳的摆放尺寸。她要彻底改变医院的管理制度。细节维系生命。