What links Florence Nightingale and Isambard Kingdom Brunel?

The 2020 Nightingale Hospital at London ExCeL.

When the Coronavirus (COVID-19) epidemic looked as though it could overwhelm the NHS, the government’s response was to build temporary hospitals in empty exhibition centres around the country.

Dubbed ‘Nightingale’ hospitals, they were erected in a very short space of time – 10 days to build a 4,000-bed facility in London’s ExCeL, with 500 of those beds fully equipped and ready to receive patients. Network Rail helped build one in the former Manchester Central railway station and there are others at Birmingham NEC, Bristol, Exeter, Harrogate and Washington.

Fortunately, they weren’t really needed, but better to be prepared than caught with the proverbial pants down.

The Nightingale name obviously refers to Florence, but, unknown to many people, there is more to it than just the fact that she was a famous nurse to link the new hospitals with her name.  For Florence Nightingale was the catalyst for the first ever rapid-deployment emergency hospital.

Florence Nightingale.

Born 200 years agio – on 12 May 1820 in Florence, Italy – Florence Nightingale came into the spotlight when she trained and managed nurses during the Crimean War (October 1853 to February 1856). She was dismayed by the conditions in the temporary hospital at Selimiye Barracks, Scutari (in modern-day Istanbul). During the winter of 1854, just over 4,000 soldiers died at the hospital.  But it was the fact that only one tenth died from their wounds, while aver 3,500 died of illnesses such as typhus, typhoid, cholera, and dysentery, that really frustrated her.

She wrote to The Times, complaining of the conditions. Her letter had two results. One was that the Sanitary Commission was sent out from London to flush out sewers and improve ventilation, which resulted in a sharp reduction in the death rate.

The other result was that Sir Benjamin Hawes, Permanent Under-Secretary to the War Office, decided that a better hospital was needed than the converted Selimiye Barracks. He planned to have a hospital built in the UK, with all possible speed, which could then be shipped to the war zone and erected on a suitable site.

Isambard Kingdom Brunel.

To design this new hospital, he turned to his brother-in-law – Isambard Kingdom Brunel.  Accepting the challenge, the noted railway engineer researched the latest hospital technology at the time and designed an all-wooden construction that could house 1,000 patients, 24 to a ward, with every pair of wards having both toilets and nurses’ rooms.

He completed the design in just two weeks!

Fabrication of the units was entrusted to Price & Co, based at Gloucester Docks. The company had supplied wooden railway sleepers to the 7ft ¼inch broad-gauge Gloucester and Dean Forest Railway and had also built huts for the army to use at Balaclava.

Brunel’s design for a twin-ward unit to accommodate 48 patients with toilets and a nurses’ room.

Surgical historian Thomas Morris reports that the rapidly constructed Renkioi hospital weighed 11,500 tons and took 23 steamers to carry it 2,000 miles to the Crimea. It was located at Erenköy on the Asiatic bank of the Dardanelles, a site that was 500 miles from the Crimean war zone but was outside of the malaria zone, unlike Florence Nightingale’s hospital at the Selimiye Barracks in Scutari.

Construction on site commenced in May and the first 300 beds were ready for occupation by 12 July. Building continued and, by 4 December, it could take 1,000 patients – 1,500 by 4 January 1856. Construction ceased in March 1856, when the war ended, by which time it had a capacity of 2,200.

Renkioi Hosptial, 1855.

The hospital was designated as a civilian hospital, controlled by the War Office but not by the Army Medical Department, so unfortunately Florence Nightingale never got to manage the hospital she had inspired.

In its short life – the hospital closed in July 1856, five months after the war ended – the hospital treated around 1,300 patients, only 50 of whom died.

Renkioi Hospital at Erenköy on the Asian side of the Dardanelles.

So, Florence Nightingale inspired, Brunel designed and a railway-sleeper manufacturer built the first offsite-manufactured hospital – designed in two weeks, manufactured in three months and open for business two months later, 2,000 miles away – in 1855.

Calling today’s emergency hospitals ‘Nightingale’ is perhaps more apt than many might think.

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