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Crimean War

Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports got back to Britain about the horrific conditions for the wounded at the military hospital on the Asiatic side of the Bosporus, opposite Constantinople, at Scutari (modern-day Üsküdar in Istanbul). Britain and France entered the war against Russia on the side of the Ottoman Empire. On 21 October 1854, she and the staff of 38 women volunteer nurses including her head nurse Eliza Roberts and her aunt Mai Smith, and 15 Catholic nuns (mobilised by Henry Edward Manning) were sent (under the authorisation of Sidney Herbert) to the Ottoman Empire. On the way, Nightingale was assisted in Paris by her friend Mary Clarke. The volunteer nurses worked about 295 nautical miles (546 km; 339 mi) away from the main British camp across the Black Sea at Balaklava, in the Crimea.

Nightingale arrived at Selimiye Barracks in Scutari early in November 1854. Her team found that poor care for wounded soldiers was being delivered by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients:

This frail young woman... embraced in her solicitude the sick of three armies.

After Nightingale sent a plea to The Times for a government solution to the poor condition of the facilities, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital that could be built in England and shipped to the Dardanelles. The result was Renkioi Hospital, a civilian facility that, under the management of Edmund Alexander Parkes, had a death rate less than one tenth of that of Scutari.

Stephen Paget in the Dictionary of National Biography asserted that Nightingale reduced the death rate from 42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary Commission. For example, Nightingale implemented handwashing in the hospital where she worked.

During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera, and dysentery than from battle wounds. With overcrowding, defective sewers and lack of ventilation, the Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Nightingale had arrived. The commission flushed out the sewers and improved ventilation. Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate. Head Nurse Eliza Roberts nursed Nightingale through her critical illness of May 1855.

In 2001 and 2008 the BBC released documentaries that were critical of Nightingale's performance in the Crimean War, as were some follow-up articles published in The Guardian and the Sunday Times. Nightingale scholar Lynn McDonald has dismissed these criticisms as "often preposterous", arguing they are not supported by the primary sources.

Nightingale still believed that the death rates were due to poor nutrition, lack of supplies, stale air, and overworking of the soldiers. After she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army, she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience influenced her later career when she advocated sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the army and turned her attention to the sanitary design of hospitals and the introduction of sanitation in working-class homes (see Statistics and Sanitary Reform).

According to some secondary sources, Nightingale had a frosty relationship with her fellow nurse Mary Seacole, who ran a hotel/hospital for officers. Seacole's own memoir, Wonderful Adventures of Mrs. Seacole in Many Lands, records only one, friendly, meeting with her, when she asked her for a bed for the night and got it; Seacole was in Scutari en route to the Crimea to join her business partner and start their business. However, Seacole pointed out that when she tried to join Nightingale's group, one of Nightingale's colleagues rebuffed her, and Seacole inferred that racism was at the root of that rebuttal. Nightingale told her brother-in-law, in a private letter, that she was worried about contact between her work and Seacole's business, claiming that while "she was very kind to the men and, what is more, to the Officers – and did some good (she) made many drunk". Nightingale reportedly wrote, "I had the greatest difficulty in repelling Mrs. Seacole's advances, and in preventing association between her and my nurses (absolutely out of the question!)... Anyone who employs Mrs. Seacole will introduce much kindness – also much drunkenness and improper conduct". On the other hand, Seacole told the French chef Alexis Soyer that "You must know, M Soyer, that Miss Nightingale is very fond of me. When I passed through Scutari, she very kindly gave me board and lodging."

The arrival of two waves of Irish nuns, the Sisters of Mercy, to assist with nursing duties at Scutari met with different responses from Nightingale. Mary Clare Moore headed the first wave and placed herself and her Sisters under the authority of Nightingale. The two were to remain friends for the rest of their lives. The second wave, headed by Mary Francis Bridgeman met with a cooler reception as Bridgeman refused to give up her authority over her Sisters to Nightingale while at the same time not trusting Nightingale, whom she regarded as ambitious.