FOR BLOOMING IN WARDS—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 knowledgeable, more persistent and penetrating in her reasoning, scrupulously 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 confidential report about her experiences. All this while Parthe and Mama lay about on sofas, telling each other not to get exhausted 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 positively 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, filthy 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 enlist 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 outright victory against her opponents, but many changes came through. Soon some barracks were rebuilt and within three years the death rate would halve. 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 civilian 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 forth 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 cramped 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 specifications. 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 linen, 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，一個研究軍隊醫務全項問題的委員會成立了。爲此付出的代價是巨大的。這項辛勞的工作交給了弗洛倫斯·南丁格爾，並不是因爲她主動請纓，而是這任務至關重要。她開始變了。變得比以往更能言善辯，更注重實效，更有見地，在論理上也更加堅定和深刻。她作風嚴謹，精益求精——這所有一切是她用犧牲所有的娛樂換來的。 1857年的夏天對弗洛倫斯來說是一場夢魘——她不僅要夜以繼日地說服參與委員會工作的政客們，還要就她的個人經歷撰寫述職報告。而與此同時帕爾絲和母親卻靠在沙發上，相互提醒着插花不要插得太累。 弗洛倫斯只用了六個月的時間就獨自完成了長達一千頁的《關於英國軍隊保健、效率和醫院管理事項的紀要》的機密報告。其闡述之清晰，考慮之深入令人難以置信。她從克里米亞學到的一點一滴都躍然紙上——每項陳述都論據充分。 弗洛倫斯·南丁格爾的基本主張是防患於未然。這在當時是標新立異的，許多政客和軍醫都覺得這過於出格同時又是稀奇古怪的。他們頑固地反對弗洛倫斯和她的支持者們。 她不得不盡力去證實士兵們的基本生活條件是造成他們死亡的原因。她調查了幾十家醫院和兵營從而發現這些地方潮溼、污穢而且通風不暢，排水管污濁並且供水系統受到污染。她指出病號飯欠佳。她根據收集的統計數據證明在和平時期年輕士兵的死亡率是普通人的兩倍。 她證實了儘管軍隊只招募最健康的年輕人，但每年仍有1500人死於疏忽大意、缺乏營養的食物和疾病。她大聲疾呼道“我們的士兵在軍營裏被死亡招募而去”，這成爲她的支持者們的鬥爭呼聲。 公衆們也站在了她的一邊。反對改革的保守派越是拖後腿，改革的壓力就越大。 儘管弗洛倫斯沒有取得對反對派的徹底勝利，但確已出現了許多變化。有些兵營被改建，三年內死亡率從預計的減少一半。 至此委員會的緊張工作告一段落，但弗洛倫斯仍要繼續研究，計劃及督促今後三十年的軍隊醫療改革。 人們現在開始希望她能將自己的學識用在民用醫院方面，這些醫院的情況在她看來和軍隊醫院“一樣糟，甚至更糟”。1859年她出了一本叫做《醫院紀要》的書。該書向全世界揭示了人們害怕去醫院的原因以及如何改良。 弗洛倫斯提出了在當時是頗爲革命的理論即只要改進並能維護醫院設施，醫院的死亡率就會大幅降低。增開窗戶，加大通風，改善排污，減少擁擠及定期刷洗地面、牆壁和牀架是所有醫院應採取的基本措施。 弗洛倫斯不久就成了醫院設施方面的專家，全世界的醫院都以她制定的細則進行設計。她坐在倫敦家裏的沙發上，寫了成百上千封的信件詢問有關洗滌槽和平底鍋、門鎖和洗衣房的情況。對她來說事無鉅細都予以細緻入微的關注。她想出辦法，最有效地來發放乾淨的被褥，最好地保溫食物的方法，牀與牀之間最佳的擺放尺寸。她要徹底改變醫院的管理制度。細節維繫生命。 弗洛倫斯·南丁格爾成功了。全世界都要建立南丁格爾式的醫院。同時弗洛倫斯將在今後的四十多年裏繼續爲醫院的規劃出謀劃策。如今的醫院鮮花盛開，窗明几淨，病房乾淨和充滿歡樂，所有這一切都應歸功於她的工作。
