Florence Nightingale (12th May 1820 - 13th August 1910) was a social reformer, statistician, and the founder of modern nursing. She came to prominence while serving as a nurse during the Crimean War, where she tended to wounded soldiers. She was dubbed
"The Lady with the Lamp" after her habit of making rounds at night.
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.
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| Florence Nightingale |
Florence Nightingale was born into a rich, upper-class, well-connected British family at the Villa Colombaia, near the Porta Romana at Bellosguardo 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. The family moved back to England in 1821, with Nightingale being brought up in the family's homes at Embley and Lea Hurst.
Her parents were William Edward Nightingale and Frances ("Fanny") Nightingale née Smith. 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.
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 spite of opposition from her family and the restrictive social code for affluent young English women.
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; he and his wife were instrumental in facilitating Nightingale's nursing work in the Crimea. She became a key adviser to him in 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 continued her travels 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
"I don't think I ever saw anything which affected me much more than this." And, considering the temple:
"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."
At Thebes she wrote of being
"called to God" while 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 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; she also received four months of medical training at the institute which formed the basis for her later care.
On 22nd 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. Her father had given her an annual income of £500 (roughly £40,000/$65,000 in present terms), which allowed her to live comfortably and to pursue her career.
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| Nightingale c1854 |
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 21st October 1854, she and the staff of 38 women volunteer nurses that she trained, including her aunt Mai Smith, were sent to the Ottoman Empire. They were deployed about 295 nautical miles across the Black Sea from Balaklava in the Crimea, where the main British camp was based.
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 which could be built in England and shipped to the Dardanelles. The result was Renkioi Hospital, a civilian facility which under the management of Dr. Edmund Alexander Parkes had a death rate less than 1/10th that of Scutari
The first edition of the Dictionary of National Biography (1911) 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. However, death rates actually began to rise to the highest of all hospitals in the region. 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. Death rates were sharply reduced, but she did not recognise hygiene as the predominant cause of death at the time and never claimed credit for helping to reduce the death rate.
Nightingale still believed that the death rates were due to poor nutrition, lack of supplies 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 attention to the sanitary design of hospitals.
During the Crimean war (October 1853 - February 1856), 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.
In the Crimea on 29 November 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognize Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund and Prince George, 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.
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| Florence Nightingale, c1858 |
Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on 9th July 1860. The first trained Nightingale nurses began work on 16th 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". Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing.
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.
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.
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.
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A print of the jewel awarded to Nightingale
by Queen Victoria,
for her services to the soldiers in the war |
From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause. An alternative explanation for her depression is based on her discovery after the war that she had been mistaken about the reasons for the high death rate. There is, however, no documentary evidence to support this theory.
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 output slowed down considerably in her last decade, she now wrote very little due to blindness and declining mental abilities, though she still retained an interest in current affairs.
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| Last photo of Florence Nightingale taken in 1910 |
On 13th August 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street, Mayfair, London. 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. She left a large body of work, including several hundred notes
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The grave of Florence Nightingale
in the churchyard of St. Margaret's Church, |
Florence Nightingale exhibited a gift for mathematics from an early age and excelled in the subject under the tutorship of her father. Later, Nightingale became a pioneer in the visual presentation of information and statistical graphics. She used methods such as the pie chart, which had first been developed by William Playfair in 1801.
Nightingale is described as "a true pioneer in the graphical representation of statistics", and is credited with developing a form of the pie chart now known as the polar area diagram, or occasionally the Nightingale rose diagram, equivalent to a modern circular histogram, in order to illustrate seasonal sources of patient mortality in the military field hospital she managed. Nightingale called a compilation of such diagrams a "coxcomb", but later that term would frequently be used for the individual diagrams. She made extensive use of coxcombs to present reports on the nature and magnitude of the conditions of medical care in the Crimean War to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports.
In her later life Nightingale made a comprehensive statistical study of sanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health service in India. In 1858 and 1859 she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".
In 1859 Nightingale was elected the first female member of the Royal Statistical Society and she later became an honorary member of the American Statistical Association.
While better known for her contributions in the nursing and mathematical fields, Nightingale is also an important link in the study of English feminism. During 1850 and 1852, she was struggling with her self-definition and the expectations of an upper-class marriage from her family. As she sorted out her thoughts, she wrote Suggestions for Thought to Searchers after Religious Truth. This was an 829 page, three-volume work, which Nightingale had printed privately in 1860, but which until recently was never published in its entirety.
The best known of these essays, called Cassandra, was previously published by Ray Strachey in 1928. Strachey included it in The Cause, a history of the women's movement. Apparently, the writing served its original purpose of sorting out thoughts; Nightingale left soon after to train at the Institute for deaconesses at Kaiserswerth.
The first official nurses’ training programme, the Nightingale School for Nurses, opened in 1860. The mission of the school was to train nurses to work in hospitals, to work with the poor and to teach. This intended that students cared for people in their homes, an appreciation that is still advancing in reputation and professional opportunity for nurses today. Florence Nightingale's lasting contribution has been her role in founding the modern nursing profession. She set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration.
In 1912 the International Committee of the Red Cross instituted the Florence Nightingale Medal, awarded every two years to nurses or nursing aides for outstanding service.
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Statue of Florence Nightingale
in Waterloo Place, London |
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