Florence Nightingale

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12 May 1820
13 Aug 1910
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Florence Nightingale, OM, RRC (/ˈflɒrəns ˈnaɪtɨŋɡeɪl/; 12 May 1820 – 13 August 1910) was a celebrated English social reformer and statistician, and the founder of modern nursing. She came to prominence while serving as a manager of nurses trained by her during the Crimean War, where she organised the tending to wounded soldiers.[1] She gave nursing a highly favourable reputation and became an icon of Victorian culture, especially in the persona of “The Lady with the Lamp” making rounds of wounded soldiers at night.[2]

Some recent commentators have asserted Nightingale’s achievements in the Crimean War were exaggerated by the media at the time, to satisfy the public’s need for a hero. Nevertheless, critics agree on the decisive importance of her follow-up achievements in professionalizing nursing roles for women. In 1860, Nightingale laid the foundation of professional nursing with the establishment of her nursing school at St Thomas’ Hospital in London. It was the first secular nursing school in the world, now part of King’s College London. The Nightingale Pledge taken by new nurses was named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday. Her social reforms include improving healthcare for all sections of British society, advocating better hunger relief in India, helping to abolish prostitution laws that were over-harsh to women, and expanding the acceptable forms of female participation in the workforce.

Nightingale was a prodigious and versatile writer. In her lifetime, much of her published work was concerned with spreading medical knowledge. Some of her tracts were written in simple English so that they could easily be understood by those with poor literary skills. She also helped popularise the graphical presentation of statistical data. Much of her writing, including her extensive work on religion and mysticism, has only been published posthumously.

Florence Nightingale was born on 12 May 1820 into a rich, upper-class, well-connected British family at the Villa Colombaia,[3] in Florence, Italy, and was named after the city of her birth. Florence’s older sister Frances Parthenope had similarly been named after her place of birth, Parthenopolis, a Greek settlement now part of the city of Naples. When Florence was 1, the family moved back to England in 1821, with Nightingale being brought up in the family’s homes at Embley and Lea Hurst.[4][5]

Her parents were William Edward Nightingale, born William Edward Shore (1794–1874) and Frances (“Fanny”) Nightingale née Smith (1789–1880). William’s mother Mary née Evans was the niece of one Peter Nightingale, under the terms of whose will William inherited his estate at Lea Hurst in Derbyshire, and assumed the name and arms of Nightingale. Fanny’s father (Florence’s maternal grandfather) was the abolitionist and Unitarian William Smith.[6] Nightingale’s father educated her.[5]

In 1838, her father took the family on a tour in Europe where he was introduced to the English born Parisian hostess Mary Clarke. Florence bonded with this woman. She recorded that “Clarkey” was a stimulating hostess who did not care for her appearance but although her idea might not always agree with her guests but “she was incapable of boring anyone.” Her behaviour was said to be exasperating and eccentric and she had no respect for upper class British women, whom she regarded generally as inconsequential. She said that if given the choice between being a woman or a galley slave, then she would choose the freedom of the galleys. She generally rejected female company and spent her time with male intellectuals. However, Clarkey made an exception in the case of the Nightingale family and Florence in particular. She and Florence were to remain close friends for 40 years despite their 27-year age difference. Mohl demonstrated that women could be equals to men, an idea that Florence had not obtained from her mother.[7]

Nightingale underwent the first of several experiences that she believed were calls from God in February 1837 while at Embley Park, prompting a strong desire to devote her life to the service of others. In her youth she was respectful of her family’s opposition to her working as a nurse, only announcing her decision to enter the field in 1844. Despite the intense anger and distress of her mother and sister, she rebelled against the expected role for a woman of her status to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in the face of opposition from her family and the restrictive social code for affluent young English women.[8]

As a young woman, Nightingale was attractive, slender and graceful. While her demeanor was often severe, she could be very charming and her smile was radiant. Her most persistent suitor was the politician and poet Richard Monckton Milnes, 1st Baron Houghton, but after a nine-year courtship she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.[8]

In Rome in 1847, she met Sidney Herbert, a politician who had been Secretary at War (1845–1846). Herbert was on his honeymoon. He and Nightingale became lifelong close friends. Herbert would be Secretary of War again during the Crimean War, when he and his wife would be instrumental in facilitating Nightingale’s nursing work in the Crimea. She became Herbert’s key adviser throughout his political career, though she was accused by some of having hastened Herbert’s death from Bright’s Disease in 1861 because of the pressure her programme of reform placed on him.

Nightingale also much later had strong relations with Benjamin Jowett, who may have wanted to marry her.

Nightingale continued her travels (now with Charles and Selina Bracebridge) as far as Greece and Egypt. Her writings on Egypt in particular are testimony to her learning, literary skill and philosophy of life. Sailing up the Nile as far as Abu Simbel in January 1850, she wrote of the Abu Simbel temples, “Sublime in the highest style of intellectual beauty, intellect without effort, without suffering … not a feature is correct—but the whole effect is more expressive of spiritual grandeur than anything I could have imagined. It makes the impression upon one that thousands of voices do, uniting in one unanimous simultaneous feeling of enthusiasm or emotion, which is said to overcome the strongest man.”[9]

Nightingale circa 1854
At Thebes, she wrote of being “called to God,” while a week later near Cairo she wrote in her diary (as distinct from her far longer letters that her elder sister Parthenope was to print after her return): “God called me in the morning and asked me would I do good for him alone without reputation.”[9] Later in 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein in Germany, where she observed Pastor Theodor Fliedner and the deaconesses working for the sick and the deprived. She regarded the experience as a turning point in her life, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work.[10] She also received four months of medical training at the institute, which formed the basis for her later care.

On 22 August 1853, Nightingale took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854.[11] Her father had given her an annual income of £500 (roughly £40,000/US$65,000 in present terms), which allowed her to live comfortably and to pursue her career.

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. On 21 October 1854, she and the staff of 38 women volunteer nurses that she trained, including her aunt Mai Smith,[12] and fifteen Catholic nuns (mobilised by Henry Edward Manning)[13] were sent (under the authorisation of Sidney Herbert) to the Ottoman Empire. Nightingale was assisted in Paris by her friend Mary Mohl.[14] They were deployed about 295 nautical miles (546 km; 339 mi) across the Black Sea from Balaklava in the Crimea, where the main British camp was based.

Letter from Florence Nightingale to Mary Mohl, 1881
Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). 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.

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 Dr. Edmund Alexander Parkes, had a death rate less than 1/10th that of Scutari.[15]

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.[16] For example, Nightingale implemented handwashing and other hygiene practices in the war hospital in which she worked.[17]

Selimiye Barracks in Üsküdar
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 Florence Nightingale had arrived. The commission flushed out the sewers and improved ventilation.[18] Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate.[19] 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.[5]

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, below).

The Lady with the Lamp[edit]

The Lady with the Lamp popular lithograph reproduction of a painting by Henrietta Rae, 1891.
During the Crimean war, Florence Nightingale gained the nickname “The Lady with the Lamp” from a phrase in a report in The Times:

She is a “ministering angel” without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.[20]

The phrase was further popularised by Henry Wadsworth Longfellow’s 1857 poem “Santa Filomena”:[21]

Lo! in that house of misery

A lady with a lamp I see
Pass through the glimmering gloom,

And flit from room to room.

In the Crimea on 29 November 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognise Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, based on her 1856 letters describing spas in the Ottoman Empire. She detailed the health conditions, physical descriptions, dietary information, and other vital details of patients whom she directed there. The treatment there was significantly less expensive than in Switzerland.

Florence Nightingale, circa 1858
Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas’ Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. Now called the Florence Nightingale School of Nursing and Midwifery, the school is part of King’s College London. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury near her sister’s home, Claydon House.

Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, though it was written specifically for the education of those nursing at home. Nightingale wrote “Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have – distinct from medical knowledge, which only a profession can have”.[22]

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organising the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: “The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing”.[23]

As Mark Bostridge has recently demonstrated, one of Nightingale’s signal achievements was the introduction of trained nurses into the workhouse system in England and Ireland from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff.

Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a recent biography disagrees,[24] saying that she was simply opposed to a precursor of germ theory known as “contagionism”. This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously; even afterwards, many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale’s work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organising field medicine. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission.

In the 1870s, Nightingale mentored Linda Richards, “America’s first trained nurse”, and enabled her to return to the USA with adequate training and knowledge to establish high-quality nursing schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.

By 1882, several Nightingale nurses had become matrons at several leading hospitals, including, in London (St Mary’s Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.

In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the first woman to be awarded the Order of Merit. In the following year she was given the Honorary Freedom of the City of London. Her birthday is now celebrated as International CFS Awareness Day.[25]

From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause.[26] Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis, the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world. Nightingale’s output slowed down considerably in her last decade. She wrote very little during that period due to blindness and declining mental abilities, though she still retained an interest in current affairs.

Although much of Nightingale’s work improved the lot of women everywhere, Nightingale was of the opinion that women craved sympathy and were not as capable as men.[27] She criticised early women’s rights activists for decrying an alleged lack of careers for women at the same time that lucrative medical positions, under the supervision of Nightingale and others, went perpetually unfilled.[28] She preferred the friendship of powerful men, insisting they had done more than women to help her attain her goals, writing: “I have never found one woman who has altered her life by one iota for me or my opinions.”[29][30] She often referred to herself in the masculine, as for example “a man of action” and “a man of business”.[31]

However, she did have several important and long-lasting friendships with women. Later in life, she kept up a prolonged correspondence with Irish nun Sister Mary Clare Moore, with whom she had worked in Crimea.[32] Her most beloved confidante was Mary Clarke, an Englishwoman she met in 1837 and kept in touch with throughout her life.[33]

Some scholars of Nightingale’s life believe that she remained chaste for her entire life, perhaps because she felt a religious calling to her career.

On 13 August 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street, Mayfair, London.[35][36] The offer of burial in Westminster Abbey was declined by her relatives and she is buried in the graveyard at St Margaret Church in East Wellow, Hampshire.[37][38] She left a large body of work, including several hundred notes that were previously unpublished.[39] A memorial monument to Nightingale was created in Carrara marble by Francis William Sargant in 1913 and placed in the cloister of the Basilica of Santa Croce, Florence.

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