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Though there was a growth in the number of hospitals in the early 19th century, conditions for patients were generally poor. Wards were often cramped and rarely cleaned, so infection spread rapidly.

Nurses were untrained, and nursing looked upon as a job for uneducated women. In the early 19th century, nurses had a reputation for drunkenness. Charles Dickens’ description of the nurse, Mrs Gamp, in his novel Martin Chuzzlewit would have been familiar to many of his readers.

Nursing was not an occupation for respectable women and it would take a determined individual like Florence Nightingale to change popular opinion.

Florence Nightingale

She found conditions in the army hospitals were appalling and began to change them for the better.

• Patients were separated according to their illness.
• Beds were spaced apart and clean air was allowed to circulate.
• Strict hygiene rules were enforced, eg patients were washed and bedding was changed regularly.

In just six months she managed to reduce the death rate significantly. To soldiers she was known as the 'Lady with the Lamp'.

Press coverage back in Britain not only made Nightingale famous but also highlighted the need for hospital reform.

When she returned to Britain in 1856, Nightingale set about transforming nursing. Instead of being just cleaners and minders, nurses were trained to be an essential part of patient care.

• With money raised from public donations, she set up the first training school for nurses at St Thomas' Hospital in London, putting into practice the ideas she had developed in Crimea.
• In 1859, she published a book, Notes for Nursing, which was a bestseller.
• She was often consulted about the designs of new hospitals which she said should include the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diets.

Nightingale had made nursing a respectable profession and had also brought about significant changes in cleanliness and patient care in hospitals.

Betsi Cadwaladr

Like Florence Nightingale, Betsi Cadwaladr also nursed British troops in Crimea and, in some ways, her story is more remarkable. She was one of 16 children from a working class family near Bala in north Wales. She left home aged 14 and in 1815, visited Waterloo and saw the suffering of the injured soldiers. She travelled the world several times, developing nursing skills as she went.

Returning to Britain, Cadwaladr trained as a nurse and in 1854, at the age of 65, went to Crimea. She did not get on with Nightingale, who she thought put too much emphasis on regulations and not enough on compassion for the injured.

After moving from Scutari, Turkey to Balaklava, Crimea, Cadwaladr was known for the long hours she worked and her insistence on keeping wounds clean. She also tried to remove rules that stopped nurses from doing their jobs. She hated the levels of bureaucracy in the British military hospitals.

She caught cholera and returned to Britain because of ill health in 1855, and died in 1860. One of the four health boards in Wales is named after her in recognition of her work.

Mary Seacole

Another nurse who made her mark in Crimea was Mary Seacole. She used her own money to travel from Jamaica to Crimea, where she was often seen going into the battlefield with her medical bag.

She also established the British Hotel near Balaklava to provide a mess-table and comfortable quarters for sick and convalescent officers, and became known as 'Mother Seacole'.