I don’t know how I could have missed this exceedingly important day in history. It really should have been on my calendar…

On October 5 (the day I should have made this entry) 1823, the extremely prestigious medical journal The Lancet, made its debut. It is published out of the UK, and has spawned a little family over the decades; The Lancet Oncology, The Lancet Infectious Diseases, and The Lancet Neurology. Published out of the UK, the journal is named for the short, wide surgical knife with a double-edged blade that is used to slice and dice patients. Now why would a medical journal be named after an instrument of torture, you may wonder. Then again, this is the land that produced Frankenstein and Dracula (Bram Stoker was Irish by birth, but wrote Dracula while living in London, while business manager of the Lyceum Theatre). No wonder they found sharp instruments so exciting, and intriguing enough to name a medical journal after one.

I am a bit prejudiced towards The Lancet since I have written extensively for it, as well as its offspring. It is a fabulous medical journal, and the staff that I’ve worked with there are some of the best to found anywhere–in regards to their professionalism and the relationship with writers.

So happy belated birthday.

Just a note from those glorious archives of healthcare history. On this date in 1918, the very first school of public health opened. The School of Hygiene and Public Health opened its doors as part of Johns Hopkins University, and its goal was “the preservation and improvement of health.” There were 16 students in the first graduating class.

I just love this history site I found. It is terrific for a history buff like me, as it contains first person accounts dating back several hundred years ago. I’ve been looking at entries related to health and nursing, but they cover all kinds of topics.

This is an interesting audio interview with a nurse named Bruce Priebe who became infected with HIV and subsequently became an AIDS activist in the 1980s.

PRIEBE: I was a nurse for eight years before I found out that I was HIV+. And I like to think that I was delivering healthcare in a caring, compassionate way and a way that did not bring any harm to anyone. And I didn’t have a personality change after I found out I was HIV+. I still feel that way. There are a lot of healthcare workers that are HIV+, including physicians. But we do not allow them to tell us that because when they do we hit them over the head with a hammer. So I can understand why people chose not to do it. Unfortunately, because again, that creates the illusion that there aren’t, that there’s just this isolated little group.

I don’t really consider myself a political activist, but you’d be amazed at how active you can become when this is happening to you and to your friends and your family. I think it’s called a lot of us into a type of activism that we might not have imagined seeing ourselves doing. We formed a civil disobedience group called the Forget-Me-Nots and we had t-shirts with pictures of people close to us who had died with their names and the dates of their birth and death. And we went to the Supreme Court and were arrested. And when we were at the FDA in 1988, we were chanting 40,000 died and I remember thinking, what a horrendous number of people — 40,000 people. And yesterday I read there were 153,000 people and God only knows how many thousands of people will have died by the time this film is seen.

Unfortunately, the audio or transcript doesn’t say if Priebe became infected in the workplace via a needlestick, or if he was a gay male who picked it up sexually, or so on. I think that information is important to the interview, as it would demonstrate that healthcare workers were very much at risk, especially in the early days of the epidemic.

For nurses working during those good old times, it probably didn’t seem that way. If nurses think that working conditions are bad now, please take a look at this except from the autobiography of Mary Roberts Rinehart, who trained as a nurse in 1893.

That first night duty was simply plain hell. Nowadays, when I have occasion to employ a nurse, she talks of eight-hour shifts, of a dozen things I do not understand. That hospital of one hundred and fifty beds, and with emergency operations day and night, was staffed with thirty nurses, all student nurses. We ran the wards, the private rooms, the operating rooms—two of them—the general dispensary, and the eye and ear clinic. Such a thing as a graduate nurse coming in to care for a private patient was unknown. Instead, during the second year of training, a small number of seniors was sent out on private duty. What was paid for them went to the hospital, not to them.

The nowadays that Mary is talking about is circa 1930, as her memoir was published in 1931. A lot had changed in the 40 years since her first night of training. Eight hour shifts–how novel. I highlighted what she said about graduate nurses coming in to care for a sick patient–hospitals back then were staffed with student nurses, give or take a few head nurses. It was your basic slave labor, and many hospitals eagerly opened nursing schools (some quite dubious) in order to get free labor that they could work as hard as they wanted, and without any restrictions on job description or hours worked. By 1930, however, it seemed that the free ride was coming to an end, and a number of labor laws had been passed.

I had three wards, C, D, and E, on that night duty. Also I had the emergency ward—E, however, was a convalescent ward, and gave no trouble. But D was a nightmare. It was the men’s medical ward, and to it came the delirious typhoid cases, an occasional delirium tremens, any sick man who needed help. Not only was typhoid still raging in the city that year, but the aftermath of the panic of ‘93 which had ruined my father had filled the wards. Disease was fostered by ill-nourished bodies, and unemployment was still rife. That winter the bread lines wound for blocks around the city streets and men lay at night for shelter on the bare floors of the station houses. When they were brought in, injured or sick, they were ragged and filthy, their bodies gaunt. Sometimes they tried to kill themselves and we got them, dazed with drugs, writhing with poison, wet from the river.

The drug cases were very bad. If the drug had been a narcotic they had to be kept awake, roused from coma; they had, as soon as possible, to be walked about. One interne had a heroic method. He knotted towels, dipped them in ice water, and beat them to keep them awake. Then, an orderly on one side, himself on the other, he walked them up and down, up and down. They would stagger, go to sleep on their feet. More ice water, more walking. When they reached the walking stage they lived.

The training was the worst of it, as the vast majority of student nurses went into private duty after graduation. A few worked for the emerging public health service, and a few must have stayed on in the hospital as a head nurse or instructor, but hospital work was primarily unpaid labor for students. Mary Roberts barely survived her training, and married a physician soon after she graduated, and never worked as a nurse. She went on to have an extremely successful career as a writer.

I’m not sure who wrote this or what this website even is, but thought it was worth repeating, just to make some nurses queasy:

During the early days of nursing, there was no uniform for nursing. They only gained popularity when Florence Nightingale, one of the first women pioneers in the medical field, established the importance of wearing nursing uniforms during the Crimean war. The first nursing uniforms were dark-gray, full-length dresses covered by white aprons. Today, nurse uniforms take on many styles and functions for seeing to the safety and security of patients.

Over the years, nursing uniforms evolved. White dresses and hose were the standard garb, but when many complained because these were impractical and difficult to work in, white tunics and pants came about. These were more comfortable to wear and nurses could actually move around easily. Nowadays, most nurses wear colored uniforms and nurse scrubs. The colored uniforms and scrubs are more convenient, since dirt or stains can’t easily be detected.

However, according to many critics, more patients are confused with colored uniforms and nurses can’t be easily picked out from the rest of the hospital staff. That is why, many hospitals reinstated white nursing uniforms with a designer flair for style and comfort. These uniforms not only give patients a sense of security, but also give nurses a level of comfort and style that they expect in their day-to-day attire.

Nursing uniforms are indeed an effective way for patients to easily recognize the nurses who take care of them. Not only that, nursing uniforms give a sense of pride to the nurses who wear them, since they are just one symbol of their love and dedication to their profession.

Everyone is entitled to their opinion, but this sweet little tribute to the “woman in white” is not only riddled with errors, it is downright silly.

The earliest uniforms were those wore by nurses who were part of religious orders, and that included both men and women. So if we want to get technical, those can be considered the first nursing outfits, and later on, secular nurses in some nations did wear uniforms based on that, ie, the veils worn by nurses in the UK and Australia (along with the term “sister” utilized).

Florence Nightingale had absolutely nothing to do with wearing uniforms, and she established no such protocol during her stint in the Crimea. At the time Nightingale took her troopers to care for the soldiers in the Crimea, she wanted to draw a strict line between nurses and hookers (yes, you read right). Her women were coming to nurse men, not to screw them, and she established strict protocols of behavior so that they would be taken seriously. At this time in England, secular nurses had a very bad reputation, and there was good reason for it.

Her nurses did not wear uniforms, and the idea never crossed Nightingale’s mind. The women wore ordinary dresses that one might wear for doing housework, and covered them with an apron, to keep them clean. And even in the first nursing programs–including the one Nightingale started in 1860–the students did not wear uniforms. In fact, the idea of wearing a uniform was repugnant, since it was something that they equated with being a maid.

The first real nursing uniform appeared in the 1880s, at Bellevue in NY. Up until this point, nursing schools and nurses did not wear uniforms. Euphemia Van Rensselaer is given credit for the introduction of the blue and white striped uniform, with the white cap and white apron, that was adopted by the school. However, the style of the dress was left to the discretion of the individual student. . By 1900 the style of the uniform was standardized, along with a distinctive cap.

The white uniform, certainly the most impractical color that could have possibly been chosen, was not always an “integral” part of nursing, regardless of those who moan and groan that it is nothing short of a threat to national security if nurses wear anything else. Up until the 1920s, the standard nursing uniform was generally a single color or striped dress, worn with a white cap and white apron. No white uniforms. And since most graduate nurses worked either as private duty nurses or for the public health system, it really didn’t matter that much what they wore. Hospitals were staffed for the most part by slave…oops..I mean student labor.

That is why, many hospitals reinstated white nursing uniforms with a designer flair for style and comfort. These uniforms not only give patients a sense of security, but also give nurses a level of comfort and style that they expect in their day-to-day attire.

It would be interesting to hear how wearing a white uniform gives a nurse a “level of comfort and style…” Blood stains really show up nicely on white, and it gets gray or yellow tinged after many rounds in the washing machine. Is wearing white really more “comfortable” than other colors? Most people also do not look particularly good in white, and I doubt there’s a great sense of comfort in knowing that every speck of dust, spill, and splatter is going to show up on your uniform. I personally find the white uniform distasteful in that it reeks of the “angel” image of nurse, one of purity and selflessness. The angel of mercy, the angel in white. Somehow, you are less angelic in scrubs.

Hospitals that are forcing nurses to wear white again have faced resistance, and the only reason that they are doing so is that they see it as some sort of PR scam. You know, that they are going to draw a larger share of patients who will flock to the hospital because their nurses are professional and wear white. Or some misguided ninny in PR thinks that forcing nurses to wear white is going to do wonders for recruitment and retention. Believe me, the return to whites is not because the nursing staff requested it.

Finally, the idea that nurses should wear white so patients can recognize them is a little outdated. Would we return to horse and buggy, simply because a lot of people used to recognize that as the means for traveling long distances? The color white is merely a blimp in the evolution of nursing dress. That’s all it is. Nurses in the US wore white for about 50 years before the dress code began to evolve. Caps mercifully vanished, and scrubs became more common. Many older patients, or those who grew up on General Hospital, still associated white with nurses, but I doubt that is true for the majority of patients. The people who diligently tune into House, ER, and Scrubs do not see nurses in pearly whites. They do not see nurses with caps on their heads. The association with white is disappearing.

Some people also think that anyone wearing a suit or a nice dress is also a doctor. Should we tell executives, QA people, social workers, pharm reps, etc., that they too, must wear a uniform so as not to confuse the patient?

Anyway, this article was just one of those silly diatribes, riddled with inaccurate information, that is trying to glorify the good old days of white–those days, I may add, when nurses were paid less than factory workers, had to stand when a male doctor walked into the room, and mopped floors as part of her duties. Thanks but no thanks.

A tidbit in medical history; on August 14, 1767, the King’s College Medical School in New York awarded the first MD degree in the U.S. Well, I guess it wasn’t the United States just yet–still just an extension of the motherland Great Britain.

So what mysterious school is this, as we no longer have any medical school’s with that name. Well, right after the Revolutionary War, in 1784, the name was changed its name to Columbia University. I guess they didn’t want any connection of old King George. Columbia has a nice “new world” sound to it, and that very same medical school is in operation today–albeit a bit more modernized than in 1767.

Some may see this as an anniversary of a great event, while others see it as the beginning of an ethical mess and mishmash. On this date in 1978, the first child was born, conceived from the use of in-vitro fertilization. Her name was Louise Joy Brown, who made her debut in England, and today turns 29.

Since that time, many parents have been able to create families with this method, but the use of IVF has been an ethical nightmare as well. One of the biggest dilemmas are the hundreds of thousands of frozen pre-embryos, that are literally sitting on ice, waiting to be either implanted in a uterus, dumped in the trash, or used for medical science. Or, as the case has been for many, sit patiently in their little petri dish until eternity. Some of these frozen embryos are more than 10 years old, and many are no longer viable. Their “mom and dad” often don’t know what to do with them. They may not wish to have any more children, but they don’t want to put their embryo up for adoption, and they feel that tossing it out is like having an abortion.

Anyway, happy birthday Louise.

Remember a few years ago when someone decided that we were about to be attacked by biologically engineered smallpox? And that we had all better go and get that new vaccine that the US government paid almost a billion dollars for? And made some drug company (I think Aventis) very happy?

Well as we know, and I’m sure that the CDC would love to bury this folly in the center of the earth, the so-called first responders largely refused to get vaccinated and the plan fizzled to a complete halt. Plus a few lethal reactions, and the military stopped jabbing its personnel as well.

And of what of the threat? Well, the threat of a biologic weapons attack vanished as well. Strange how those things coincided.

But the reason I’m even mentioning smallpox now, is that today is one of those dates in medical history. In April 1721, when the U.S. was still a British colony, the first cases of smallpox arrived in Boston on a ship from the West Indies. The disease spread rapidly, as smallpox tends to, but the physicians of the day vehemently opposed a pamphlet that encouraged them to adopt an African practice in which the patient was given a weakened form of the disease to prevent getting the more dangerous strain.

Now, not to get up on the soapbox, but even back then, doctors were stubborn and stuck in what was considered “read medicine.” Same as today. Just as many docs pooh-pooh anything that doesn’t involve a prescription pad or surgery, it seems that they were of the same mindset almost 300 years ago. Even though they had absolutely no way of treating smallpox or preventing it, they weren’t willing to try a new method that might save lives. Sound familiar?

Anyway, on this date in 1721, a gentleman by the name of Zabdiel Boylston began inoculating a small group of patients, including his own two sons. When word got out that Boylston had ignored the ordinance that forbid vaccination, he was actually attacked by angry mobs. Why, I have no idea. But then, angry mobs often are a bit irrational. Especially in a case like this, where the vaccination might mean the difference between death and survival. People who survive smallpox are often terribly disfigured, so that was an incentive in and of itself.

Three years later Boylston packed up and left the Puritans behind, and sailed for London. His expertise was well received. It would be another 75 years before Edward Jenner developed the vaccine for smallpox that would eventually lead to eradication of the disease.

Unless of course, you believe Pres. Bush.

On this date in 1860, the first 15 students entered the training program with St. Thomas’s Hospital in London. It was Florence Nightingale’s grand experiment, which as we all know, was a great success in some respects and backfired badly in others. But whatever, it is a date indelibly etched into the archives of nursing history.

To all you mothers out there, both of human children and fuzzy ones–hope you’re getting royal treatment.

But if you believe Florence Nightingale (her again!) and medical historian Victor Robinson, motherhood is very similar to nursing (the profession, not breastfeeding). Nightingale vehemently opposed the attempts of English nurses to organize, have licensing exams, and to have a license to practice. She states that “nurses cannot be registered and examined any more than mothers.” Well, considering some of the mothers I’ve had to deal with, maybe exams and licensing wouldn’t be a bad thing. We might end up with a lot less screwed up kids, but that’s for another discussion. Basically, she equated nursing with motherhood, as an “instinctive” sort of skill. Moms comfort crying babies, give children baths, put a band-aid on a boo-boo, and I guess in FN’s eyes, nurses did the same thing. Only they had to follow doctor’s orders as to when was the appropriate time to kiss the boo-boo.

Victor Robinson, who was a physician and a writer, echoed that sentiment in his book White Caps, the Story of Nursing (1946) when he wrote, “Woman is an instinctive nurse taught by Mother Nature.” Hmm…even for 1946, that was pretty backward thinking, considering the skill and expertise shown by wartime nurses. It was more than just smoothing sheets and emptying a bed pan. Just to note, Vic also thought it was marvelous that the numbers of female doctors had been decreasing (thanks to efforts by the AMA no doubt) in the early 20th century. He felt that nursing was certainly a much more suitable career for women.

Just like moms–long hours, little to no compensation, no respect from society…. Funny how he should think that a lowly paid job with little chance for advancement (remember, this is 1946) was the best thing for women, whereas medicine, along with its good pay, prestige and great opportunities for advancement and independence, was not. I guess Victor never considered male nurses in the grand scheme of things, or the fact that learning anatomy and physiology has little to do with maternal instinct.

Still Florence Nightingale’s birthday. I celebrated by going to Whole Foods and then to the drugstore to buy a new super sonic toothbrush. Cool. What do you think about that, Flo?

Anyway, this is the second part of my rendition of the life and times of Florence Nightingale. I decided to do this in a Q & A format, just to make it easier to address some of the most urban of the urban legends concerning Ms. Nightingale.

Was Florence Nightingale a feminist?

This question has been bounced around and been around the block more than a few times. Some say yes, others no. I say no.

While FN was unhappy with the status quo, and indeed, who could blame her, she never stepped out beyond the confines of her day. She was very much an upper class Victorian woman, and while she believed that women such as herself should be able to pursue more than just a suitable marriage and producing miniature Victorians, she never really pushed for women’s rights. She only wanted the freedom to do be able to do something useful with her life, and she wanted to be a nurse. But concepts such as careers for women, equal rights, equal pay, etc., never crossed her agenda.

And FN was certainly no 19th century Che Guevera. As much as she wanted to be a nurse, she would have never dreamed of disobeying her parents and going off on her own and find a nursing job. For one thing, Daddy would have had a fit and probably cut off her allowance. And poor Florence, image living on a pitiful nurse’s salary. Here was a woman who had probably never even brushed her own hair, or boiled the water for her tea. She probably wouldn’t have even know what to do if she dared leave her own front door unescorted.

FN was 30 years old before her parents finally relented and allowed her to go to Germany to study nursing, under strict supervision. And the nursing school that she created, and her vision for nursing in general, fit right into Victorian ideals. A revolutionary this woman was not.

In the mind of FN, she imagined that the women coming to study nursing would be all upper class, and interested in fulfilling a sacred calling. What a shock when middle and lower class girls began knocking on the door, seeing nurses as a welcome means to earn a living, at a time when options were exceedingly few for women. In response to this rude awakening, the St. Thomas training school set up a double tier; lady probationers, who were the upper class chicks that Flo hung around with, and the nurse probationers. The lady probationers were groomed to be the nursing leaders of tomorrow, while the nurse probabationers were groomed to do the scut work.

Men were excluded entirely, and this double tier system replicated itself in the U.S. Only here, however, the system largely excluded not only men, but minorities. Some schools were a little kinder and set up quotas for Jews, blacks, Roman Catholics, Indians, etc. Basically, the goal was to fill the nursing ranks with white Protestant women, and even today, American nurses are still primarily white women.

Did she die of syphillis?

I don’t really know how that started, but it is unlikely. Most probably, FN contracted brucellosis in the Crimea, and that was probably the reason why she spent the last half century of her life in almost total seclusion. And anyway, some think that she was a lesbian, so it doesn’t sound like she would have been too keen to sleep around with men.

Did FN help or hinder nursing as a profession?

Both. She helped make nursing respectable, but at the same time, did her best to destroy the notion that it was a profession. FN had no clue as to what life was like for the average woman, especially those with limited means. She had this idea that nursing was a religious calling, and that the women called to it should put aside such silly ideas as licensing exams, competence, scientific training, decent pay, or being able to support oneself. Better to starve to death, or sleep in the gutter because you can’t pay your rent—those were better options than tainting nursing by calling it a profession, and unionizing.

FN lived in the lap of luxury from birth until death, completely supported by her family’s money. Nurses, she seemed to think, all had rich fathers to support them, and therefore all could walk around dreamy-eyed and play angel.

Her desire to keep men out also turned nursing into women’s work, which was not highly thought of. Translation–low pay, low in respect, long in hours.

Why are Nightingale’s other accomplishments basically ignored?

Good question. The same thing is true for Clara Barton, who tends to listed as an “American nurse” or the “American Florence Nightingale.”

I have no idea why this nurse tag predominates in both FN and Clara Barton. In the case of Barton, she was a schoolteacher, then a patent clerk, and when the Civil War broke out, she loaded up a wagon and took it out to the battlefield because men were dying and the bureaucracy was too slow in getting them supplies. She never studied nursing, or claimed any desire to help the sick and needy. After the war, she helped locate missing soliders for several years, and then eventually went on to head up the American Red Cross. All in all, she spent about 3 years doing nursing, if you can call it that. That is 3 years out of a very long life, and yet Barton is called a nurse to the exclusion of all else she did.

Same with FN. Granted, FN did want to be a nurse and care for the sick, but again, she spent only abut 3 years of her 90 year lifetime actually doing patient care. She spent the rest of her life as a reformer, architect, statistician, health educator, and adviser to the military. Her accomplishments were huge, but yet they are forgotten and most people have no idea that FN did anything more than walk around with lamp and “place a cool hand on a fevered brow.”

I’ll take it a bit further, and probably ignite the wrath of the nurse police, but I think her later accomplishments were the far more important ones. She redesigned healthcare and hospital systems, and began the concept of keeping real health statistics–as I said in the previous post, she developed the idea that social phenomena could be objectively measured and subjected to mathematical analysis.

Now I’ll really get in trouble, but perhaps nursing might have developed quite differently had FN not stuck her nose into it. There were already people who thought that nurse should be trained, and indeed, FN herself went to a school in Germany. Nursing would have evolved with or without her, and perhaps if she hadn’t been around, a different system would have taken root. Men, for example, have been nursing since Biblical times, and there were male nurses during FN’s time. Poet Walt Whitman worked as nurse during the Civil War.

As medicine evolved, and the need for trained nurses grew, it may have been a whole other ball game. But I guess we’ll never know.

Happy birthday, Florence.

So, as every good nurse should know, today is Florence Nightingale’s birthday. The most loved, loathed, revered, and ridiculedperson in the great annals of nursing history. Also the most misunderstood, and I should say, overstudied and both over and underestimated.

Today is Florence Nightingale’s birthday. She was born May 12, 1820 in Florence, Italy. I guess her parents didn’t have too much imagination in nameing their daughter. There are some great links all over the Internet about old Flo, who is nearing her 200th birthday. Some are the sappy sort, which go on and on about her saintliness, and how she saved all of those men in the Crimea (which she didn’t, by the way), and how she was the “first” real nurse (like no one had been doing any nursing for the first few millenniums of human existance), and she revolutionized nursing–well, that she did, for better and worse. Intermingled are some really good in-depth and critical accounts of her life and work, which allow us to see past that sickeningly sweet image that she has unfortunately been coated with.

But for now, let’s take a brief look at Florence. Aside from the iconic nurse, she was a brilliant mathematician. She designed military medical facilities, and played a pivotal role in recreating hospital architecture. Her first act on returning to England in 1858, following the Crimean War, was not to start a nursing school as is commonly believed, but to contribute to a massive report to the government on the sanitary condition of military hospitals.

This was a rather personal mission for her. You see, despite all the hype and glory, Florence was not responsible for bringing down the death toll in the Crimea. Yes, her nurses scrubbed and washed the soldiers, changed their beds, gave them nourishing food to eat, but that only made them more comfortable and did not lead to a lower death toll. The majority were dying of disease, not of their wounds.

From the BBC:

But if one looks at the historical record more carefully, one begins to realise that, despite Nightingale’s work at Scutari, the death-rate among the soldiers did not begin to fall; on the contrary, it began to rise. Historians are now waking up to the shocking truth that the death toll at Nightingale’s hospital was higher than at any other hospital in the East, and that her lack of knowledge of the disastrous sanitary conditions at Scutari was responsible. During her first winter at Scutari, 4,077 soldiers died there, ten times more from illnesses such as typhus, typhoid, cholera and dysentery, than from battle wounds. Conditions at the hospital were fatal to the men that Nightingale was trying to nurse: they were packed like sardines into an unventilated building on top of defective sewers.

As Hugh Small, author of a recent study of Florence Nightingale in the Crimea, has written, this pioneering woman was effectively presiding over ‘a death camp’. A sanitary commission, sent out by Palmerston’s government in March 1855, almost six months after Nightingale’s arrival at Scutari, flushed out the sewers and improved the ventilation, thereby dramatically reducing the mortality rate. However, Nightingale herself continued to attribute responsibility for the high number of deaths to inadequate nutrition and supplies, and to the army’s sending of men across the Black Sea to Scutari when they were already half-dead from exposure.

It was only on her return to Britain, when she began collecting evidence to present before the Royal Commission on the Health of the Army, that Nightingale changed her mind, reaching the painful conclusion that most of the soldiers at her hospital had been killed by bad sanitation, due to her ignorance. She had helped them to die in cleaner surroundings and greater comfort, but she had not saved their lives.

Florence Nightingale’s ignorance kept them dying. This is interesting because although reports conflict, it is believed that she never believed in “germs.” She supposedly refused to look through microscopes, and considered illness to be due to something more mysterious. This would mesh in with her steadfast belief that malnutrition and lack of soap were killing the men in Scutari. And this experience also may have lead for her fanatical beliefs in “fresh air” for patients–to open windows and not keep the sick in sealed up rooms for fear of a draft. I kind of think that patients in modern hospitals would be well to get a little fresh air and sunshine, but that’s another story.

So her guilt led to her become the foremost expert on hospital design, to maximize efficiency and health and wellbeing. And this was the first thing she dove into after the war, before she ever considered creating a training school for nurses.

Now, let’s get into the obvious. The lady with the lamp. The ministering angel. Yada, yada, yada. While the myth and legend spread like wildfire, it is quite the opposite of the real situation in the Crimea. Florence did not spend her time there floating through corridors, cooling fevered brows with just the touch her hand, and healing the battered soldiers with her sweet smile.

From the History News Network:

Early reports in the press, soon swelled by an extraordinary outpouring of verse and song dedicated to the romantic heroine, portrayed her as a ministering angel, a hands-on nurse, personally attending to soldiers as they lay on mile upon mile of mattresses. Yet, although she sometimes spent 10 or 12 hours a day in the first weeks working on the wards, her principal role was administrative, supervising the nurses rather than directly nursing the sick.

What is recognised less often than it should be is that Nightingale stands as the figurehead for 229 women who nursed in Turkey and the Crimea from 1854 to 1856, most of them in hospitals that stood outside Nightingale’s jurisdiction. Of these, only 17 served for the duration; the others were dismissed for a variety of forms of misconduct, including drunkenness, or were invalided out, resigned, or simply died. Nevertheless, these 229 demonstrated that women could play a decisive role in the Army in wartime.

She was also said to be a strong willed woman, who was often less than pleasant and difficult to work with. And that makes sense. If Florence had been a docile sweet Victorian maiden, she wouldn’t have accomplished anything. The military would have squished her like a cockroach. It took a strong person to crack the military’s perception that nursing was not needed, that “real” soliders should suffer and if necessary, die for the glory of Queen and country.

Finally, Florence was a brilliant and accomplished statistician. She may have been influenced by Quetelet in Belgium, but she developed the idea that social phenomena could be objectively measured and subjected to mathematical analysis. She was an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics.

In 1840, Florence begged her parents “to let her study mathematics instead of doing worsted work and practicing quadrilles.” As you can see, she was not a good upper class Victorian daughter. Her mother “did not approve, home duties were not to be neglected for mathematics.” She assumed that her daughter’s destiny was marriage, “and what use were mathematics to a married woman?” Her father, who loved math and had communicated that love to his daughter, nevertheless urged her to study more subjects that were more appropriate for a woman, such as “history or philosophy, natural or moral. Florence expressed her preference for mathematics by saying, “I don’t think I shall succeed so well in anything that requires quickness as in what requires only work.” Her parents finally granted permission.

Interesting how science and math have always been seen as more masculine, while history and philosophy more suited to women. I suppose that is was assumed that studying science and math takes some analytical ability, as opposed to just memorizing facts or contemplating, and the female brain just wasn’t equipped for that.

Unfortunately, Florence rarely gets any credit for these accomplishments, and instead, much of her contributions to society are buried in that tiresome image of the lady with lamp.

I’ll write more later on Florence. The juicy stuff is yet to come…well, I consider it more juicy, because her myth indicates that she created nursing a respectable profession, when it fact, it was the farthest thing from her mind. She also wasn’t keen on women’s rights, but primarily the right of bored and intelligent upper class ladies such as herself to be allowed to do something constructive with their lives. Lower class women were already busy enough trying to survive and eek out a living, and Florence was not concerned with their welfare.

…and so was everyone else who had an inkling of healthcare training.

On April 26 (which is today, in case you didn’t know)1986, one of four reactors at the Chernobyl nuclear power plant in the Ukraine melted down. Yes, the big meltdown, and probably one of the things that hastened the end of the Cold War, when the world saw a glimpse of what the aftermath of a nuclear war might be like.

The accident contaminated thousands of people with low-level radiation, and the extend of this damage is still unfolding before our eyes. It is a work in progress, unfortunately, and we may not see the true and entire impact for some time to come. But needless to say, the Soviet Union was ill prepared to handle it.

In 1996, International Chernobyl Conference in April 1996 documented 800 cases of thyroid cancer among children who were younger than 15 when their diagnosis was made. People who decided to sty in the contaminated zone–for whatever reason–have a mortality rate that is 18% higher than the general population. The rate of thyroid cancer is 10 times as high as it was before the accident occurred.

So the moral of the story is don’t play with nukes, keep your nuclear reactors in tiptop shape, and if the things starts to bubble over, get the hell out of town.

Hypodermic needles and syringes–those things scare me and I try to avoid them at all cost. But I doubt that there is scarcely a nurse on this planet who hasn’t stuck one of those pointy things into a defenseless patient at least once during the course of her career.

But I bet that hardly anyone knows (or cares) that on March 12, 1845, Irish physician Francis Rynd published his account of how he used a hypodermic syringe to inject fluids into a patient at Dublin’s Meath Hospital. The beginning of a new era of pain, and well, also tremendous progress in medicine. Now medicines could be given which circumvented the digestive tract and got into the blood stream more quickly.

From the Canadian Journal of Anesthesia:

In 1845, the Irish surgeon Francis Rynd (1801-1861) became the first to introduce a fluid subcutaneously. In order to treat a patient with trigeminal neuralgia, Rynd developed a special instrument which could inject a morphine solution beneath the skin: “On the 3rd of June a solution of fifteen grains of acetate of morphia, dissolved in one drachm of creosote, was introduced to the supra-orbital nerve, and along the course of the temporal, malar, and buccal nerves, by four punctures of an instrument made for the purpose.”

Rynd published his results in the Dublin Medical Press, and it would still be a while before intramuscular injections were introduced. Still, this was quite a milestone in medicine and healthcare.

As usual, I am a little behind in my musings on famous dates in medical history. On Sept 1, 1858, Gray’s Anatomy first appeared in print. And no, I am not talking about the TV show, unless some of you think that the ladies and blokes living in Victorian England had television sets–and the electricity to power them.

It is interesting how famous this textbook is, considering that it contains no explosions, wanton sex, infidelity, murder, incest….well, you get the idea. The book was first published under the title Gray’s Anatomy: Descriptive and Surgical in Great Britain in 1858, and the following year in the United States. Dr. Henry Gray, a lecturer in anatomy St. George’s Hospital Medical School in London, spent much of his career writing anatomical essays on various parts of the body. I guess he didn’t get out much.

In 1855 he approached his colleague Dr Henry Vandyke Carter with his idea to produce an anatomy text book for medical students, and so, Dr. Gray went to work, never dreaming that his book would soon become better known as a silly medical TV soap. Did I say silly? Sorry, don’t mean to insult viewers, but I find nearly all medical “dramas” to be more of the making of Hollywood than real life.

The final product was a culmination of all his previous works, but unfortunately, Dr. Gray’s time on earth ended in 1861, only three years after the publication of his masterpiece. He contracted smallpox, shortly after he was promoted to the position of assistant surgeon at St. George’s. Poor Dr. Gray was only 34 years old, and smallpox was a dreadful way to die. Interestingly, the smallpox vaccine had been perfected over 60 years earlier, in 1796 by Edward Jenner, so you may wonder why a physician did not avail himself of it. If he had, Dr. Gray may have lived on to see his book become a classic in its own time.

The latest edition of Gray’s Anatomy is the 39th edition, published on November 25, 2004 in the UK and November 24, 2004 in the U.S., which is also available in CD-ROM format. Naturally, knowledge of human anatomy has expanded since Gray’s time, so the big has grown and blossomed.

Conjoined twins were recently separated in Utah, in a rather experimental surgery that had never been done before. The girls had only one kidney between them, which meant that one gets the kidney and the other dialysis until a donation. It was because of the kidney that separation wasn’t attempted until the girls were four years old, and from all accounts, they are recovering nicely. Of course, they will need extensive rehab and physical therapy (each girl only has one leg), and subsequent surgeries as they grow, and of course, due to their convoluted organ system, they may have a rocky road ahead.

But at any rate, I thought that it was suitable to mention the most famous duo of all, Chang and Eng Bunker. The original Siamese twins. Not the first in history, of course, but the best known and from whom the term “Siamese twin” was derived. On this date in 1829, the twins journeyed to Boston from their native Siam (now known as Thailand) to be displayed in your usual freak show.

But they didn’t do so badly for themselves. They traveled with their agents Robert Hunter and Abel Coffin, who made them world famous. They eventually married sisters, had 21 children between them, and lived to be 63 years old. I always find it amusing to read accounts of their death which say that they”died within hours of each other in 1874.” No kidding. You’re connected, and if one dies, it’s not likely the other is going to survive for two long. Then again, it is difficult to say how intricately entwined the two were. They were only minimally joined at the chest, and some experts say that they could have been separated, even with the technology of the time. But separation probably would have been psychologically traumatic, to say nothing of ending their lucrative career.

And we have no idea what was inside their body, although, judging from the outer appearance, they seemed to be joined at the sternum by a thin piece of cartilage. The brothers eventually settled on a plantation in North Carolina, bought slaves, adopted the name “Bunker, ” and lived out their lives as Southern gentlemen.

My feature story for the Lancet Infectious Diseases is now out in the August issue. Yes, I know most of you don’t read the Lancet or any of its offspring, but a lot of the articles in there are surprisingly readable if you’re not a doc or super scientist. I think they have really good stories and editorials about healthcare issues, and of course their news coverage is the best (I write for all of the Lancets so I’m a prejudiced). But anyway, I was honored when I was asked to do a feature story on the history of AIDS treatment, in line with the 25th anniversary of the first published report.

And now as a big surprise, my article is available for free. Access to the Lancet family is restricted, but several articles are usually available to anyone who wants to read them. My wonderful article was selected for the August issue. So click away, and read on. Of course, it is not a comprehensive history. I only had 1500 words, and I had to basically cut it in half, and take out two interviews. But I think it covers the basics. The early days were the most trying and frightening times, especially combined with people like Ronald Reagan who didn’t mention the disease publically until six years after it had been raging through the country. I guess when nice white middle-aged Republicans in the Midwest suddenly found themselves infected, then he decided it was time to acknowledge the disease.

Anyway, it is hard to believe that 25 years have passed since that first report. That there are people growing up and reaching adulthood who didn’t know about a life before AIDS.

If any of you have been following the news about Medicare’s Plan D, that brave new experiment in prescription drugs, you’ll know that it can be summarized in one word: MESS. Or: CHAOS.

It’s new, there will be kinks, but come on, some of the things going on are beyond ridiculous. They’ve had about two years to prepare for this–it’s not like the plan was announced in November, with January 1 as the implementation day.

But I really don’t want to blog about the Medicare mess. I do enough of that in my writing career. I just thought it was notable to mention a historic day, considering the rather chaotic situation going on with the Plan D roll-out.

Today, or should I say, three days ago, was a notable day in the history of healthcare. President Lyndon Johnson presented the first Medicare card to former President Harry S Truman on January 20, 1966. And look at the scene 40 years later.

President Truman ceremoniously received his card at the Truman Library in Independence, Mo., and the second Medicre card to be issued was presented to Harry’s wife, Bess. The Medicare bill was signed into effect in 1965, at the Truman Library, strangely enough. During his presidency, Truman had tried to get a national health insurance program passed by an unreceptive Congress–now does that sound familiar?

Not what you think. This is the cover-up of another kind, and of a different president. It is a great addition to the annals of health and medical history, even though I am a day late. I did mean to post this yesterday, but our server is down, and email was a mess–don’t ask. Even now, thinks are still not back to normal.

What does Grover Cleveland have in common with George Bush? Both have White House secrets, albeit Bush’s a little bit more serious. And both men have dealt with the problem of popular vote vs. electoral vote. In Bush’s case, he lost the popular vote in 2000, won the electoral vote, and amidst a highly contested election, somehow became president.

Cleveland, on the other hand, lost his bid for re-election in 1888, even though he won the popular vote. But Benjamin Harrison won the electoral vote, so he became president. So even back then, it was obvious that the electoral college needed the boot. However, not to go into that…

Good old Grover made a comeback, though, and was elected president in 1892, the only president to serve two nonconsecutive terms. He is also the only president to be married in the White House, and the only one (to my knowledge) who publically admitted fathering a child out of wedlock during the campaign, and still managed to be elected. And this in 1892. To think, that 100 years later, Clinton was going to be impeached for getting a blow job from a consenting adult.

But what is fascinating is how Cleveland managed to keep his health problems a secret. Granted, there was no Internet, television, faxes, or any other high speed news delivery systems we take for granted. Still, the United States was in the middle of a financial crisis, and the president and staff wanted to prevent an investment crisis at all cost.

On June 13, 1893, Cleveland noticed a “rough place” on the roof of his mouth, which was ultimately diagnosed as cancer. In one of the most celebrated incidents in the history of Presidential medicine, and there have been a few, Cleveland pulled a risky coup in order to keep his political opponents ignorant of his condition. He was transported to New York, placed in a yacht that was anchored near Bellevue Hospital, and operated on while on the boat. The surgery necessitated the removal of much of his jaw, and he was fitted with a prosthetic jaw. It must have been a damn good one, because the public hadn’t a clue about this until a decade after his death in 1907.

I am astonished that such a complicated procedure was successfully performed in 1893, and a prosthesis made that looked so natural. The surgeon who performed the surgery was William Williams Keen, who was born on January 19, 1837. Even more astounding is that the operation was performed entirely within the president’s mouth to conceal any scars.

Since we’re on the subject, another great presidential medical cover-up was Woodrow Wilson’s stroke, which left him incapacitated. His condition was kept secret and his wife took over his responsibilities. Franklin Roosevelt also kept the fact that he couldn’t walk well hidden. While it was well known that he had contracted polio, it was believed that he could walk with the aid of crutches–when in fact, he was paralyzed from the waist down.

Another smoking haven bites the dust. Now, let it be known, I am a non-smoker and also have mild asthma. I don’t like the smell of cigarette smoke. My moronic father used to smoke in the car when he was driving, and I used to get so carsick, but do you think the asshole would put out his Kent? Not a chance. Everywhere he went, he had a lit cigarette, and even used to smoke in our windowless non-ventilated bathroom. Anyway, my father’s lack of mental functional is another story, but the point being, I do not have fond memories of cigarettes and smoking.

But while I can understand smoking bans in public areas, in airplanes, and in areas where employees are packed into one room, ie, cubicle farms, I don’t think that the government has any right to ban smoking in private businesses. For instance, if a person has a private office, why can’t they smoke in there? And why can’t restaurant and bar owners decide for themselves whether or not they want to ban smoking?

I know, it’s to protect the employees. Well, a person does have a choice whether or not to choose a smoke friendly or smoke free environment to work in. The very nature of a bar indicates that it is a place where people come to indulge in a very unhealthy habit–drinking alcohol. If we really want to protect the health of employees, then we should ban bars–and that would help prevent people from being killed and injured by drunk drivers.

They put a new law in place in Seattle. So now, the streets are full of smokers, standing outside and blocking the sidewalk. Loud noisy drunks blowing cigarette smoke. Cool. We get to sniff smoke en masse, and people passing by have to weave their way through a forest of smoke and loud tipsy folks. I have read of people in NY complaining of the street noise now, beneath their window, as smokers come out of bars to puff away. They usually come out in twos and groups, so now residents living above the bars get to listen to annoying conversation until the wee hours of the morning. And smell the smoke wafting up.

Personally, I prefer eating and drinking in a smoke-free environment. But philosophically/politically, the decision of smoking on the premises should be left up to restaurant/bar owner, not the government.

And here’s an interesting health related tidbit. Usually smokers are fairly spread out in restaurants, and the smell from a lone cigarette doesn’t bother me. But walking in and out past a herd of them makes me cough. Sometimes there may be five or more people out front smoking, and all of that smoke, together in one spot, is really irritating to my lungs. So much for improving health.