Nightingale, Florence (1820–1910)

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Nightingale, Florence (1820–1910)

Pioneer nurse and public-health advocate, who is considered one of the great heroines of Victorian England for her nursing work in the Crimean War. Born in Florence, Italy, on May 12, 1820; died in London, England, on August 13, 1910; buried in the family grave at East Wellow (in deference to her wishes, the offer of burial in Westminster Abbey was declined); daughter of William Edward Nightingale and Fanny (Smith) Nightingale; had one sister, Parthenope Nightingale; educated by governesses, by her father at home, and by extensive European travel; never married; no children.

Superintendent of a London nursing home (1853); served in the Crimean War (1854–56); had no subsequent official appointments but was a perpetual political lobbyist on health-reform issues.

Florence Nightingale was one of the great heroines of Victorian England, and tales of her selfless service in the Crimean War edified two generations of British children. Lytton Strachey tried to smash the myth when, in Eminent Victorians, he wrote that she was a "bitter creature" possessed by "a demon" and that she was one of the age's most ruthless and manipulative women. Both versions were exaggerations: Nightingale was heroic and intolerant, just as she was both deeply traditional and, in her distinctive way, a precursor of feminism.

She was born in Florence in 1820, where her rich and leisured family was staying as part of a three-year tour, and named after the city. The Nightingales returned to England a year later and then divided their time between houses in London, Derbyshire, and the New Forest. Rich and privileged, Florence grew up with every material advantage and showed intellectual flair. Her father took command of her education when she was 12 and taught her Latin, Greek, Italian, and French in addition to history and mathematics. She also developed a passion for statistics and on a second family trip to Italy when she was 17 she recorded details of distances and speeds in her notebooks. That was also the year when she became convinced that God had called her to a special work, though for a long time she could not bring the nature of His call into sharp focus.

Attractive, intelligent, and popular, Nightingale won the attention of several suitors, but she turned down the two most ardent of them, her cousin Henry Nicholson and the poet and parliamentarian Richard Monckton Milnes. She found the family's perpetual round of social calls and the restraints imposed on her as a young heiress irksome, and began to withdraw into long reveries which her family interpreted as signs of possible mental illness. Feeling trapped, and often involved in bitter arguments with her mother and sister, she even considered suicide, and sank into ever lower spirits in the late 1840s and early 1850s as she turned 30.

Gradually, she determined that her vocation was nursing. The family was horrified. The social status of nurses was low; contemporary cartoons show nurses as slovenly drunkards, often promiscuous. The Nightingales wanted to protect their gifted daughter from what they saw as a degrading waste of her life. One biographer describes the hospitals of the era, in which Nightingale proposed to work:

The huge wards, with beds jam packed together, were filthy, their floors and walls saturated with blood and ordure, and the "hospital smell" was such as to induce nausea in anyone entering a ward for the first time. The patients were filthy and verminous; bedding stank and was seldom changed; infections of every kind were prevalent; gangrene was rife. The surgeons with their blood-bespattered clothes and unsterilized knives spread infection as well as agony and terror among their patients.

After a long succession of arguments with her family, she went to Kaiserwerth, in Germany, where a nursing school had been established. There she learned the elements of nursing, on the basis of which she was able, two years later, to get a job as superintendent of the Institution for the Care of Sick Gentlewomen in London's Harley Street. Her parents were totally opposed to this work, and the privileged society ladies on the home's board were amazed at Nightingale's efficiency and her unseemly stubbornness to get her own way. From the beginning, she was interested as much in organization as in actual hands-on nursing, though in this job she had to do a great deal of both, and teach her employees by example. The next year, 1853, she nursed the dying in one of London's worst cholera epidemics.

In 1854, Britain went to war against Russia in the Crimea. The war was made famous by the Charge of the Light Brigade, a notable disaster in British military annals, soon to be commemorated in Alfred, Lord Tennyson's poem. The blundering of the British military leadership was reported by William Russell, a London Times correspondent. Russell also reported that British casualties of the war were being ill-treated at inadequate hospitals in the Turkish town of Scutari, across the Black Sea from the Crimea. Florence Nightingale, reading Russell's reports, resolved to help, and set out for Constantinople with 38 volunteers, half of them nurses of the old type whose only motive was the prospect of regular pay. Most of the rest were Roman Catholic sisters, whose presence scandalized the Anglican Church establishment. In her preparations, however, Nightingale was backed by Sidney Herbert, secretary of state, who had earlier befriended her and admired both her skill in planning and her determination.

Lytton Strachey">
At times, among her intimates, [Florence Nightingale's mother] almost wept. 'We are ducks,' she said with tears in her eyes, 'who have hatched a wild swan.' But the poor lady was wrong; it was not a swan that they had hatched; it was an eagle.
—Lytton Strachey

For a privileged woman to appear at the scene of a war, amid the gruesome carnage of a military hospital, there was no precedent in British history. Dr. Menzies, the head of the hospital, and the army's medical chief, Dr. John Hall, were unhelpful and resentful, especially as Nightingale quickly discovered that they had neglected elementary sanitary arrangements. The building, a former Turkish army barracks, was immense but virtually unfurnished—there were no tables in the place, even for operations, and no cooking equipment to feed the thousands of sick and wounded men. In Strachey's vivid description:

Huge sewers underlay the building, and cesspools loaded with filth wafted their poison into the upper rooms. The floors were in so rotten a condition that many of them could not be scrubbed; the walls were thick with dirt; incredible multitudes of vermin swarmed everywhere.

Nightingale at once began to spend money which a Times subscription had raised, on suitable food, stoves, linens, and other supplies. The doctors' early resistance to having nurses at work in the wards evaporated when hundreds more wounded men appeared following the battle of Balaklava that winter. Nightingale witnessed amputations, sometimes without chloroform anesthetic, and the deaths of hundreds from wounds, shock, disease, and even starvation. She was vexed when Sidney Herbert, her ministerial ally, permitted another 46 volunteer women, none of them trained as nurses, to come from England to Scutari where they were more hindrance than help. She sent them on to another makeshift hospital at Therapia, and subsidized them with her own money to get their work properly under way. To her annoyance, this group, led by Mary Stanley, who was in the process of converting to Catholicism, spent as much time on religious as on medical work, despite the horrible conditions. From both groups, some nurses had to be sent back to England for drunkenness and sexual improprieties.

At Scutari, Nightingale improved sanitation as far as possible, carried out repairs to a ruined part of the hospital and built a boiler-laundry on her own initiative and at her own expense. She arranged for the men to be laid out in all available spaces, including the corridors. Walking the rounds of the whole hospital, which she did every evening, carrying a lamp, gave rise to the sobriquet "Lady of the Lamp" about which Longfellow later wrote a sentimental poem. Soldiers stopped cursing in her presence and, it was widely reported, kissed her shadow as it passed by. These nightly rounds of the hospital encompassed four miles of corridors in all; one of Nightingale's assistants described it:

It seemed an endless walk and was not easily forgotten.… Miss Nightingale carried her lantern, which she would set down before she bent over any of the patients. I much admired her manner to the men—it was so tender and kind.… The hospital was crowded to its fullest extent. The building, which has since been reckoned to hold, with comfort, seventeen hundred men, then held between three and four thousand.

It needed great presence of mind for Florence Nightingale to remain patient in the face of remediable obstacles. Keeping her temper while confronting military obstructionism and red tape required superhuman self-control. Often food, linen, shirts, boots, and other vital supplies were landed at Scutari, but she was forbidden to use them until they had been guided

through official army channels, which could take weeks or even months.

The winter of 1854–55 witnessed an outbreak of scurvy among the neglected men, and hundreds were disabled by frostbite. In the worst weeks of bitterly cold weather, three-quarters of the British army (which was nearly 40,000 strong) was sick or wounded. Florence Nightingale sent a constant stream of angry but informative letters to Secretary of State Herbert, and he passed some of them on to Queen Victoria , who sent her a letter of congratulation and a medal. Bit by bit, Nightingale remedied the worst abuses of the system but even so was powerless to prevent a death rate of more than 100 each week, many of which could have been prevented, even by the limited medical methods of the time. A mixture of military and medical disasters brought down the government early in 1855 and Herbert lost his position. Herbert's successor, Lord Panmure, also sympathized with Nightingale and organized a Sanitary Commission along lines she had suggested to investigate the Crimea. The Commission was led by John Sutherland, who became a lifelong friend to Nightingale and was a pioneer in British public health and sanitation. Under his supervision, the Scutari water supply was purified, drains cleared, rubbish removed efficiently, beds replaced, and the walls whitewashed with lime.

When the weather was warmer, Nightingale crossed the Black Sea to visit the front lines at Balaklava and Sebastopol. There too, her determined reform work won the admiration and support of some officers, and the resentment and obstruction of others. She was doubtless a difficult, obstinate person, hated to be contradicted, and could not bear any signs of human weakness in those around her. After a year of working ceaselessly, she collapsed with a fever at Balaklava and was in imminent danger of death. News of her sickness reached England and set off a wave of grieving, for, by now, Nightingale was a national hero. A dispatch from the British commander Lord Raglan that she was recovering provoked national rejoicing. Though she returned to Scutari, the fever left permanent marks on her health. Now that the hospitals were in good order, she turned to other reforms, trying to reduce drunkenness among the soldiers and to offer convalescents the chance to read or, for the many illiterates in the ranks, to learn reading for the first time. She also arranged a system whereby soldiers could send all or part of their pay back to families in Britain. This arrangement, which the men entered into confident of Nightingale's absolute trustworthiness, helped their families at home and, by removing disposable income, made drunkenness and gambling less of a temptation in the camps.

Nightingale stayed in the Crimea and Scutari for another year, plagued by rivalries among the services, jealousies among army medical personnel, and calumnies spread by women she had reprimanded. Angry and suspicious, at times she sounded paranoid and at her worst accused even her loyal followers of betraying her trust. Luckily, her good qualities outweighed these weaknesses, and she remained the center of popular and political enthusiasm at home. The secretary of state issued a clarifying order in March 1856 declaring that she was "the General Superintendent of the Female Nursing Establishment of the Military hospitals of the Army" and that "the Principal Medical Officer will communicate with Miss Nightingale upon all subjects connected with the Female Nursing Establishment, and will give his directions through that lady." It was a victory for her but it came only two weeks before the war ended, and after supervising the evacuation of the remaining hospital patients she prepared to go home.

Hating publicity and reluctant to face official celebrations, she traveled home incognito and appeared before her family in Derbyshire unannounced. She turned down all invitations except one from Queen Victoria, whom she visited at her Scottish home, Balmoral. She told the queen that the entire system of military medicine must be overhauled so that catastrophes like the Crimea would not recur in future campaigns. With the queen's backing, she helped organize a Parliamentary Royal Commission, and lobbied to make her old friend Sidney Herbert chair. As a woman, she could not be a member, but she wrote a massively documented 1,000-page account of her experiences in the war which served as the basis of the commission's deliberations. The burden of the report was that the army should improve its preventive medical arrangements and forestall epidemics by feeding, clothing, and caring better for its men before they fell sick. Through statistical studies, she found English barracks to be so unhealthy that even during peacetime the army's death rate was far higher than the general population's, even though it was recruited from among the nation's youngest and healthiest men. Bacteria and viruses had not yet been discovered, and the nature of disease transmission was not properly understood. Nightingale and her followers knew from firsthand experience, however, that lack of ventilation, lack of cleaning, and poor sanitation all made hospital wards more dangerous to their inhabitants and deduced that the same problems afflicting barracks would make them unhealthy too. Bad in England, these conditions were worse in India, and she devoted much time in the late 1850s and early 1860s to gathering detailed information about the vile conditions endured by soldiers in the Indian empire.

The commission reports she helped midwife were followed up by practical reforms, under the supervision of Herbert but with Nightingale as guiding genius. From this time forward, barracks and hospitals were built to new designs, with better ventilation, and the soldiers began to receive a better diet and more humane treatment. After further bureaucratic struggles, the Army built its own medical school, as Nightingale had asked, but still threw up obstacles to its success. Herbert, overcome by her exhausting demands and increasingly sick, died in 1861, aged only 51. Far from sympathizing in his last days, she hectored him to work harder than ever in the time remaining to him. Only after his death was she stricken with remorse at having imposed so heavily upon him. From then on, she grieved for him as "the Master" with almost the same ardor that Queen Victoria showed in lamenting the recently dead Prince Albert.

Nightingale's Notes on Hospitals (1859) outlined her plans for reforming both civil and military hospitals. Every detail caught her attention, and the book, frequently reprinted, became a guide to European and American cities and governments planning new medical facilities. She also tried to introduce systematic gathering of statistics so that the nature of diseases and their frequency, mortality rates, ages at death, and other basic health matters, could be tabulated for the whole country, something never previously attempted. Notes on Nursing, another book from 1859, was her most popular, and under its example the level of nursing care available in Britain began gradually to rise, stimulated by the launching of an experimental nursing school at St. Thomas' Hospital, London. Full of detailed suggestions for training effective nurses, Notes for Nurses included this telling passage:

I would earnestly ask my sisters to keep clear of both the jargons now current everywhere, of the jargon, namely, about the "rights of women," which urges women to do all that men do, merely because men do it, and without regard to whether this is the best thing women can do; and the jargon which urges women to do nothing that men do, merely because they are women…. Surely woman should bring the best she has, whatever that is, to the work of God's world, without attending to either of these cries.

She never gave any energy to the women's suffrage cause even though she agreed that women should have the suffrage; "I think no one can be more deeply convinced than I." She had learned instead how to intrigue effectively behind the scenes and how to win the loyalty and devotion of men in power. Many of the most prominent men in public life devoted themselves to her causes, often getting scant thanks in return but never freeing themselves from her grip. Her largest writing project was an 800-page book of philosophy and theology, Suggestions for Thought to the Searchers after Truth Among the Artisans of England (1860), which included her proofs of the existence of God. Lytton Strachey quipped that "her conception of God was certainly not orthodox. She felt towards Him as she might have felt towards a glorified sanitary engineer; and in some of her speculations she seems hardly to distinguish between the Deity and the Drains."

Ever since her return from the Crimea, Florence Nightingale had been sick, and by the late 1850s thought she was at the brink of death. In fact, she would live on for another 50 years, outliving most of her family and friends, but throughout the last five decades she was a permanent invalid, carried outside only rarely and living for the most part on a couch in her South Street house in London. She continued to work an exhausting schedule on reform projects, however, and was so busy that she often sent away visitors unless they had come on business. Even some of her best friends from earlier days were denied access and no one was too important to be turned away; she even refused to receive the queen of Holland who came on a courtesy call.

Among the many causes to which Nightingale gave her time and energy in later years were the alleviation of puerperal fever in childbirth wards, the relief of the sick poor in workhouse wards, and constant attention to the suffering of both civil and military populations in India. A long succession of viceroys visited her before setting off for the subcontinent, and although she never went there, she exerted her will at every level of Indian life in trying to improve sanitary conditions and nutritional standards.

In 1901, she virtually lost her eyesight but still lived on for another nine years in the care of devoted servants. She died in 1910, aged 90, believing that her most valuable work had been achieved not in the Crimean War but in the later decades, as nurses trained according to her methods spread throughout the empire and hospital standards improved everywhere. "In Miss Nightingale's own eyes," as Strachey wrote, "the adventure of the Crimea was a mere incident—scarcely more than a useful stepping-stone in her career…. For more than a generation [afterwards] she was to sit in secret, working her lever; and her real life began at the very moment when, in the popular imagination, it had ended." She was, unquestionably, the single most important source for the transformation of nursing and a major contributor to carrying out the ideals of public health in society.