Lesson video

Hello, I'm Mr. Marchant and I'll be your history teacher for today's lesson.

I'm looking forward to guiding you through today's resources and helping you to achieve today's lesson objective.

By the end of today's lesson, you'll be able to evaluate the impact of Florence Nightingale on hospital care in the 19th century.

There are three keywords which will help us navigate our way through today's lesson.

Those are sanitary, infirmary, and ward.

If something is sanitary, it relates to preventing disease by removing dirt and waste.

An infirmary is another word for a hospital.

And a ward is a room in a hospital where people receiving treatment stay.

Today's lesson will be split into three parts and we'll begin by focusing on problems in early 19th century hospital care.

In the 18th century, there was a significant expansion in the availability of hospital care in Britain.

However, despite this improvement, there were still major issues with hospital care by the early 19th century.

These included staffing and sanitary conditions.

Hospitals were usually staffed by both doctors and nurses in the early 19th century, although this was not always the case.

Workhouses, locations where some of the poorest people were sent, often had their own infirmaries to care for the sick.

However, these were not appealing locations for medical professionals to work in, and the people who ran them did not want to spend a lot of money on medical care.

As a result, most workhouse infirmaries had just one doctor and no dedicated nursing staff.

In fact, until 1863, there was not a single trained nurse working in any workhouse infirmary outside of London.

In the 18th century, the training received by doctors in Britain had improved significantly, helping to improve the care they could provide in hospitals.

By contrast, nurses generally lacked any medical training.

Although many nurses worked hard, they typically had a poor reputation amongst both patients and the general public.

For example, one of the many characters created by the author Charles Dickens was Sarah Gamp, a fictional nurse.

Dickens portrayed Gamp as sloppy, incompetent, and drunk.

So let's think about everything we've just heard.

First, we've got a statement on the screen, which reads, "Many workhouse infirmaries suffered from poor staffing." But is that statement true or false? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said that that statement was true, but we need to be able to justify our response.

So why is it that that original statement was correct? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said it was typical for just one doctor to work in a workhouse infirmary, and there were frequently no dedicated nursing staff at all in those infirmaries.

And let's try another question.

Which of the following characteristics was often associated with nurses? Cleanliness, drunkenness, expert knowledge or kindness? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said that in the 18th and 19th centuries, drunkenness was often associated with nurses rather than any more positive characteristics.

Infections, such as septicemia or hospital gangrene, which were fairly uncommon outside of hospitals, killed many patients in the early 19th century.

In fact, the danger posed by infections in hospitals was so severe that it was referred to as hospitalism.

Indeed, some doctors even questioned whether hospitals were doing more harm than good.

In large part, the danger posed by hospitalism was a result of unsanitary conditions.

For one, hospitals often had poor facilities.

Little ventilation was provided for wards, and there were normally few toilets for patients.

One medical report observed a ward in a workhouse infirmary where 30 men had been required to use one toilet in which there had been no water for more than a week, and which was in close proximity to their ward.

Overcrowding and poor hygiene practises among staff added to these problems. For instance, many doctors and nurses did not wash their hands or change clothes between patients, which helped to spread infections as well.

So let's check that we have a secure understanding of everything we've just heard.

What did hospitalism refer to? Was it the cleanliness of hospitals, infections in hospitals, or support for hospitals? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said the correct answer was B, hospitalism referred to the severe problem posed by infections in 19th century hospitals.

And this time I want you to study the image, which you can see on the screen.

It's a cartoon which shows a hospital ward with a doctor and patients.

I want you to identify one way in which the cartoon suggests early 19th century hospitals were unsanitary.

So pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who identified one of the following details, that patients are close together, which would make it easy for infections to spread, and that people and animals can be seen defecating in the ward.

So it's clearly not a sanitary space.

So we're now in a good position to put all of our knowledge of problems in early 19th century hospital care into practise.

I want you to describe the problems which affected hospital care in Britain during the early 19th century, and you should include the following terms as part of your answer: training, hospitalism and unsanitary.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your hard work on that task.

So I asked you to describe the problems which affected hospital care in Britain during the early 19th century.

And your answer may have included: staffing was a major issue in British hospitals in the early 19th century.

For example, workhouse infirmaries, which cared for many poor patients, often had just one doctor and no dedicated nursing staff.

In other hospitals where nurses were present, they usually lacked training and were commonly portrayed as being drunks.

Furthermore, unsanitary conditions in hospitals meant their infections were very common.

Indeed, so many hospital patients died from infections like septicemia that this danger was referred to as hospitalism.

So really well done if your own response looked something like that model, especially if you were able to include each of those three terms which I asked you to.

So we're now ready to move onto the second part of our lesson for today where we are going to consider improvements in hospital staffing.

In the second half of the 19th century, there was a noticeable improvement in nursing in British hospitals.

This improvement was largely the result of the influence of Florence Nightingale.

Florence Nightingale gained fame in Britain for her work providing care to wounded British soldiers during the Crimean War.

Many wounded soldiers had suffered due to inadequate care and poor conditions in military hospitals.

However, Nightingale, who was in charge of a team of nurses sent to the Crimea, oversaw changes which helped reduce death rates from 40% to just 2%.

Nightingale's work was celebrated back in Britain and helped her develop a strong reputation for her medical work.

When she had returned to Britain at the end of the Crimean War, Nightingale was able to use her reputation to help improve the state of nursing back home.

For instance, a Nightingale Fund had been set up in 1855 to support the training of new nurses, and by the end of the Crimean War, £45,000, worth roughly £3 million in today's money, had been raised.

Nightingale was able to use this money to set up the Nightingale School for Nurses in 1860.

This school was attached to St Thomas' Hospital in London and was the first professional school for nurses in Britain.

The education provided at the school focused on many key ideas included in Nightingale's 1859 book, "Notes on Nursing." This included teaching nurses elementary science and emphasising the importance of good sanitation in hospitals.

For example, nurses were encouraged to wash their hands regularly during the day.

The school also ensured that its nurses followed a strict moral code to help them maintain a positive reputation.

Between 1860 and 1903, nearly 2,000 Nightingale nurses received certified training at the Nightingale School for Nursing.

These nurses went on to work in hospitals across the country.

For instance, 12 Nightingale nurses began working in the Liverpool Workhouse Infirmary in 1865.

Nightingale nurses also helped to support the training of future generations of nurses as they took leading roles in hospitals and new nursing schools.

By the end of the 19th century, standards of care had improved and nursing had become a well-respected profession in Britain.

So let's check we have a secure understanding of everything we've just heard.

What did Florence Nightingale set up in 1860? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was the Nightingale School for Nurses.

And let's try another question.

Which of the following was not a key part of the training provided at the Nightingale School for Nurses? Was it elementary science, germ theory, or good sanitary practises? Pause a video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was B, germ theory was not a key part of the training provided at the Nightingale School for Nurses.

And let's try a third question.

Which example best demonstrates that Nightingale nurses were able to help the poor? Is it that between 1860 and 1903, nearly 2,000 Nightingale nurses received certified training, that the reputation of nursing as a profession had improved significantly by 1900, or that trained nurses began working in the Liverpool Workhouse Infirmary in 1865? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was C, trained nurses began working in the Liverpool Workhouse Infirmary in 1865.

As workhouse infirmaries were where many poor people received hospital treatment, this shows that Nightingale nurses were able to help the poor.

So we're now in a great position to put all of our knowledge about improvements in hospital staffing into practise.

So how did Florence Nightingale help to improve nursing in Britain? As part of your answer, you may consider standards of nursing, the availability of nursing care and the reputation of nursing.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your effort on that task.

So I asked you how did Florence Nightingale help to improve nursing in Britain? And your answer may have included, Florence Nightingale helped improve nursing in Britain by setting up the Nightingale School for Nurses in 1860.

The school was the first of its kind, providing certified training to nurses, including a focus on elementary science and the importance of good sanitation.

Nearly 2,000 Nightingale nurses had received training at the school by 1903, helping to improve standards of care and improving nurses' reputation as a profession.

Furthermore, trained Nightingale nurses went on to work in many locations, including in workhouses, which had generally lacked dedicating nursing staff.

For example, in 1865, 12 Nightingale nurses began working at the Liverpool Workhouse Infirmary.

So really well done if your own response looks something like that model, which we've just seen.

And that means we're now ready to move on to the third and final part of our lesson for today where we're going to think about improvements in hospital conditions.

Florence's Nightingale's influence did not only help to improve nursing in Britain.

Based on the experience she gained in the Crimean War, Nightingale also focused on improving the way hospitals were designed and constructed in Britain.

Florence Nightingale was convinced that the design of hospitals could make a major difference to a patient's health and chances of recovery.

Although Nightingale's ideas to overcome hospitalism were informed by her belief in the incorrect theory of miasma, many of the reforms she proposed were effective.

For one, Nightingale supported the construction of hospitals which followed a pavilion plan, featuring larger rooms with more windows and separate wards for different groups of patients.

More windows improved ventilation, which reduced the risk posed by certain infections like flu while separate wards made it harder for infections to spread between patients.

Because of Nightingale's reputation, many hospitals were built according to pavilion plans, including in London, Glasgow, Manchester, and Birmingham.

Nightingale also encouraged the separation of toilets from patient wards to prevent contamination and promoted the use of tiled floors and painted walls to make it easier to wash out surfaces.

The growing acceptance of germ theory after the 1860s helped provide further justification for these methods and ensured that by the end of the 19th century, good sanitation became a leading priority for hospitals in Britain.

So let's check our understanding of everything we've just heard.

I want you to write the missing word from the following sentence.

Florence Nightingale recommended a blank plan for hospitals featuring larger, separate wards and many windows.

So what's the missing word? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the missing word was pavilion.

Florence Nightingale recommended a pavilion plan for hospitals featuring larger, separate wards and many windows.

And let's try another question.

This time we have a statement which reads, "Nightingale's recommendations about hospital design were largely ignored." Is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false, but we need to be able to justify our response.

So why is it that that original statement was incorrect? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said Nightingale was well-respected, so many hospitals across Britain, including in London, Manchester, Birmingham, and Glasgow were built according to her recommended pavilion plan.

And let's try another question.

Which idea initially informed a lot of Florence Nightingale's thoughts about hospital design? Was it germ theory, miasma, or the Theory of the Four Humours? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was B.

Although the idea was incorrect, a lot of Florence Nightingale's thoughts about hospital design were initially informed by her belief in the theory of miasma.

So we're now in a good position to put all of our knowledge about improvements in hospital conditions into practise.

I want you to study Aisha's view.

Aisha says that Florence Nightingale's ideas made hospitals significantly less deadly for patients.

How far do you agree with Aisha's view? I want you to explain your answer in two paragraphs.

So pause the video here and press play when you're ready to reflect on your response.

Okay, well done for all of your hard work on that task.

So I asked you how far did you agree with Aisha's view? And your answer may have included, "Aisha is correct that Florence Nightingale's ideas helped to make hospitals less deadly as she reduced the danger known as hospitalism posed by infections.

Firstly, Nightingale recommended changes in hospital designs, like the use of pavilion plans.

These plans included many windows for improved ventilation and separate wards for different groups of patients, both of which made the spread of infections less likely.

Similarly, Nightingale's arguments that toilets should be separated from wards made contamination less likely.

Because Nightingale's ideas were widely accepted, many new hospitals followed her recommendations from the 1860s onwards.

So many patients benefited from these ideas.

The training which Florence Nightingale supported and helped to provide for nurses was also important in making hospitals less deadly for patients.

For instance, the Nightingale School for Nurses had a key emphasis on the importance of cleanliness and taught nurses to wash their hands regularly.

Although this was a simple practise, it had previously been uncommon in hospitals.

As more nurses were trained according to Nightingale's ideas, nursing practises in hospitals became more sanitary, and the risk of nurses themselves spreading infections from one patient to another were reduced.

Therefore, Florence Nightingale's influence on both nursing and hospital design certainly did make hospitals less deadly for patients." So really well done if your own response looks something like that model, which we've just seen.

And so now we've reached the end of today's lesson, which puts us in a good position to summarise our learning about the growth of hospital care in the 19th century.

We've learned that hospitals in the early 19th century were usually unsanitary and staffed by untrained nurses.

The common danger posed by infection in hospitals was referred to as hospitalism.

Florence Nightingale had a good reputation in Britain, which helped her initiate medical changes.

The Nightingale School for Nurses provided certified training for nurses, helping to improve the standard and reputation of nursing in Britain.

And pavilion designs for hospitals featuring larger, separate wards with many windows became common from the 1860s onwards.

So really well done for all of your effort during today's lesson.

It's been a pleasure to help guide you through our resources today, and I look forward to seeing you again in future as we continue to think about medicine in Britain and health and the people.