Florence Nightingale

• 1. Introduction

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  Florence Nightingale was born on the 12th of May 1820 at the Villa Colombaia in Florence, Tuscany, and was named after the city of her birth. She would become an English social reformer, a statistician, and the founder of modern nursing. A phonograph recording captured her voice in 1890, in aid of the Light Brigade Relief Fund. On it she says, "When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life." The recording closes with a blessing for her old comrades of Balaclava. That single fragile recording hints at a life crowded with contradiction. How did a wealthy young woman, expected only to marry and bear children, end up breaking into locked storage with a hammer to reach medicine for wounded soldiers? Why did the woman who did so much for women's work also write that women were not as capable as men? And how did a nurse become the first female member of the Royal Statistical Society? Each of those puzzles has its own answer, and each opens onto another.

• 2. Scutari And The War

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  On the 21st of October 1854, Nightingale and a staff of 38 women volunteer nurses were sent to the Ottoman Empire. Among them were her head nurse Eliza Roberts and her aunt Mai Smith, alongside 15 Catholic nuns mobilised by Henry Edward Manning. The mission was authorised by Sidney Herbert, then Secretary of War, and on the way she was assisted in Paris by her friend Mary Clarke. The nurses worked about 295 nautical miles from the main British camp at Balaklava.

  Nightingale arrived at the Selimiye Barracks in Scutari early in November 1854. The site sat on the Asiatic side of the Bosporus, opposite Constantinople, at what is now Üsküdar in Istanbul. Her team found wounded British soldiers cared for by overworked medical staff amid official indifference. Medicines ran short, hygiene was neglected, and mass infections spread, many of them fatal. There was no equipment even to process food for the patients.

  During that first winter at Scutari, 4,077 British soldiers died. Ten times more died from illnesses such as typhus, typhoid, cholera, and dysentery than from battle wounds. After Nightingale sent a plea to The Times, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital, shipped to the Dardanelles as the Renkioi Hospital. Under Edmund Alexander Parkes, Renkioi achieved a death rate less than one tenth of Scutari's.

  The sewers told the real story. With defective sewers, overcrowding, and no ventilation, a Sanitary Commission was sent to Scutari in March 1855, almost six months after Nightingale arrived. It flushed the sewers and improved ventilation, and death rates fell sharply. Stephen Paget, in the Dictionary of National Biography, asserted that Nightingale reduced the death rate from 42 percent to 2 percent. She herself never claimed credit for the reduction. When she fell critically ill in May 1855, it was Eliza Roberts who nursed her through it.

• 3. The Lady With The Lamp

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  A report in The Times gave Nightingale the name that would follow her for life. It described her slender form gliding quietly along each corridor as every poor fellow's face softened with gratitude. When the medical officers had retired and darkness settled over miles of prostrate sick, the report said, she could be seen alone, with a little lamp in her hand, making her solitary rounds. From that passage came "The Lady with the Lamp."

  Henry Wadsworth Longfellow carried the image further in his 1857 poem "Santa Filomena." The phrase became fixed in Victorian imagination, and Nightingale became an icon of that culture. The persona was of a ministering angel moving among wounded soldiers at night.

  The troops had another name for her. They called her "the lady with the hammer," after she used a hammer to break into locked storage and reach medicine for the wounded. The war correspondent Russell thought such behaviour unladylike, and he invented an alternative. That alternative was the gentler image of the lamp that endured.

• 4. A Privileged Education

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  Florence's older sister was named Frances Parthenope, after Parthenope, a Greek settlement now part of Naples. The family moved back to England in 1821 and raised their daughters at Embley in Hampshire and Lea Hurst in Derbyshire. Her father was William Edward Nightingale, born William Edward Shore, who inherited the Lea Hurst estate under the will of Peter Nightingale and took the name and arms of Nightingale. Her maternal grandfather was the abolitionist and Unitarian William Smith. From both sides she inherited a liberal-humanitarian outlook.

  Her father educated her himself, an unusual choice for the time. With Parthenope she studied history, mathematics, Italian, classical literature, and philosophy. A BBC documentary noted that Florence was the more academic of the two girls, displaying an early ability for collecting and analysing data that she would use to great effect. Women of her class did not attend universities, and their purpose in life was understood to be marriage and children.

  In 1838 her father took the family on a tour of Europe, where she met the English-born Parisian hostess Mary Clarke. "Clarkey" did not care for her appearance and had little respect for upper-class British women, whom she regarded as inconsequential. She once said that if forced to choose between being a woman or a galley slave, she would choose the freedom of the galleys. She generally rejected female company, yet she made an exception for the Nightingales. She and Florence stayed close for 40 years despite a 27-year age difference, and Clarke showed Florence an idea she had not learned from her mother, that women could be equal to men.

  Nightingale underwent the first of several experiences she believed were calls from God in February 1837 at Embley Park. The experience prompted a strong desire to serve others. She respected her family's opposition to nursing in her youth, announcing her decision to enter the field only in 1844. Her mother and sister were angry and distressed, but she rejected the expected role of wife and mother. Her most persistent suitor, the politician and poet Richard Monckton Milnes, courted her for nine years before she rejected him, convinced that marriage would interfere with her calling.

• 5. Calls And Confidants

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  In Rome in 1847, Nightingale met Sidney Herbert, a politician on his honeymoon who had been Secretary at War. The two became lifelong friends, and she became his key adviser. Some accused her of hastening Herbert's death from Bright's disease in 1861 through the pressure of her reform programme. She also later formed strong relations with the academic Benjamin Jowett, who may have wanted to marry her.

  Travelling with Charles and Selina Bracebridge, Nightingale reached as far as Greece and Egypt. In Athens she rescued a juvenile little owl from children who were tormenting it, naming the owl Athena and often carrying it in her pocket until the pet died shortly before she left for Crimea. Sailing up the Nile to Abu Simbel in January 1850, she wrote of the temples there as "Sublime in the highest style of intellectual beauty, intellect without effort, without suffering."

  At Thebes she wrote of being "called to God." A week later, near Cairo, she wrote in her diary, "God called me in the morning and asked me would I do good for him alone without reputation." Later in 1850 she visited the Lutheran community at Kaiserswerth-am-Rhein in Germany, observing Pastor Theodor Fliedner and the deaconesses caring for the sick. She called it a turning point in her life and issued her findings anonymously in 1851 as her first published work, The Institution of Kaiserswerth on the Rhine. She also received four months of medical training there.

  On the 22nd of August 1853, Nightingale took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, holding it until October 1854. Her father had given her an annual income of 500, which let her live comfortably and pursue her career. That income made the next chapter possible, when her central focus turned to a military hospital on the far side of the Bosporus.

• 6. Founding A Profession

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  On the 29th of November 1855, in the Crimea, the Nightingale Fund was established at a public meeting to recognise her war work, and donations poured in. Sidney Herbert served as honorary secretary and the Duke of Cambridge as chairman. With 45000 from the fund, Nightingale set up the Nightingale Training School at St Thomas' Hospital on the 9th of July 1860. It was the first secular nursing school in the world, now the Florence Nightingale Faculty of Nursing and Midwifery at King's College London. The first trained Nightingale nurses began work on the 16th of May 1865 at the Liverpool Workhouse Infirmary.

  Notes on Nursing, published in 1859, became the cornerstone of the curriculum, though Nightingale wrote it for those nursing at home. In it she argued that sanitary knowledge ought to be held by everyone, distinct from the medical knowledge only a profession can have. The book sold well to the general public and is considered a classic introduction to nursing. Joan Quixley of the Nightingale School later wrote that it was the first of its kind ever written.

  Mark Bostridge has shown that one of her signal achievements was introducing trained nurses into the British workhouse system from the 1860s, so that sick paupers were no longer cared for by able-bodied paupers. Charles Dickens had caricatured the earlier standard of care in his 1843 to 1844 novel Martin Chuzzlewit, in the figure of Sarah Gamp, incompetent and corrupt. Caroline Worthington of the Florence Nightingale Museum said that when Nightingale started out there was no such thing as nursing, and that hospitals were places of last resort where floors were laid with straw to soak up blood.

  Nightingale advocated autonomous nursing leadership, with matrons holding full control over their staff. The Guy's Hospital dispute of 1879 to 1880, between matron Margaret Burt and the medical staff, showed how doctors felt their authority challenged by the new style of matron. In the 1870s she mentored Linda Richards, "America's first trained nurse," who became a pioneer in the United States and Japan. By 1882 Nightingale nurses had become matrons at hospitals across Britain and as far as Sydney Hospital in New South Wales.

• 7. Numbers As Argument

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  Florence Nightingale was elected the first female member of the Royal Statistical Society in 1859, and became an honorary member of the American Statistical Association in 1874. She had shown a gift for mathematics from an early age, excelling under her father's tutelage. She became a pioneer in the visual presentation of information, using methods such as the pie chart, first developed by William Playfair in 1801 and still novel in her day.

  Her best-known device is the polar area diagram, sometimes called the Nightingale rose diagram, equivalent to a modern circular histogram. She used it to illustrate seasonal sources of patient mortality in the field hospital she managed. The form had been used earlier by Andre-Michel Guerry in 1829 and by Leon Louis Lalanne by 1830. Nightingale called a compilation of such diagrams a "coxcomb," and used coxcombs to present the conditions of medical care to Members of Parliament and civil servants who would have been unlikely to read traditional statistical reports.

  Her attention turned to the British Army in India, where she demonstrated that bad drainage, contaminated water, overcrowding, and poor ventilation drove the high death rate. In 1858 and 1859 she lobbied successfully for a Royal Commission into the Indian situation, which completed its study in 1863. After 10 years of sanitary reform, she reported in 1873 that mortality among soldiers in India had declined from 69 to 18 per 1,000.

  The Royal Sanitary Commission of 1868 to 1869 let her press for compulsory sanitation in private houses. She lobbied the minister James Stansfeld to strengthen the Public Health Bill, requiring owners of existing properties to pay for connection to mains drainage, and the strengthened law passed in the Public Health Acts of 1874 and 1875. Working with the retired reformer Edwin Chadwick, she also pushed to devolve enforcement to local authorities. Historians now believe that drainage and devolved enforcement helped raise average national life expectancy by 20 years between 1871 and the mid-1930s.

• 8. Faith, Feminism And Final Years

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  Nightingale wrote some 200 books, pamphlets and articles, and during 1850 and 1852 she struggled with her self-definition against the expectation of an upper-class marriage. Out of that struggle came Suggestions for Thought to Searchers after Religious Truth, an 829-page, three-volume work she had printed privately in 1860. Its best-known essay, "Cassandra," protests against the over-feminisation of women into near helplessness, the kind she saw in her mother's and sister's lethargic lifestyle. Cassandra was a princess of Troy cursed by Apollo so that her prophetic warnings would go unheeded. Elaine Showalter called Nightingale's writing "a major text of English feminism, a link between Wollstonecraft and Woolf."

  Nightingale held complicated views on women despite all this. She believed women craved sympathy and were not as capable as men, and she preferred the friendship of powerful men. She wrote, "I have never found one woman who has altered her life by one iota for me or my opinions," and often called herself "a man of action" and "a man of business." Yet she kept lasting friendships with women, including the Irish nun Mary Clare Moore and the pioneering computer programmer Ada Lovelace, on whose death from cancer at 36 in 1852 she wrote of "the tremendous vitality of the brain, that would not die."

  Her faith resisted easy labels. Though named a Unitarian in older sources, she remained in the Church of England with unorthodox views, influenced early by the Wesleyan tradition. She believed in universal reconciliation, that even those who die without being saved will eventually reach heaven, and she comforted a dying young prostitute with that view. She argued that secular hospitals usually provided better care than religious ones, and that health workers chiefly concerned with their own salvation were inferior to those driven by professional desire.

  From 1857 onwards Nightingale was intermittently bedridden and suffered from depression, possibly from chronic brucellosis traced to a "Crimean fever" she experienced in May 1855. From home she selected and purchased flannel by mail order, a new method conceived by the Welsh entrepreneur Pryce Pryce-Jones, who used her name as a customer in his advertising. She died peacefully in her sleep at 10 South Street, Mayfair, on the 13th of August 1910, at the age of 90. Her relatives declined the offer of burial in Westminster Abbey, and she lies in the churchyard of St Margaret's Church in East Wellow, Hampshire, beneath a memorial bearing only her initials and her dates. Since 1965 her birthday has been marked each year as International Nurses Day.