Florence Nightingale

English nurse and social reformer

• Born: May 12, 1820
• Birthplace: Florence (now in Italy)
• Died: August 13, 1910
• Place of death: London, England

Florence Nightingale revolutionized the nursing profession and the design and conditions of medical care and hospital facilities.

Early Life

Florence Nightingale was named after the Italian city of Florence, Italy, in which she was born. Her mother, Frances (Fanny) Nightingale, was a socially ambitious and strong-willed woman. Her father, William Edward Nightingale, was a scholarly and liberal Cambridge man. Nightingale had one older sister, Parthe, and when the family returned to England, the sisters’ education was first handled by governesses but soon taken over by their father. Thus, both girls received a broader and more liberal education than many women of their day. This early introduction to a competitive and intellectual world rather than a purely social and domestic one was a great influence on Nightingale.

As a teenager, Nightingale was surrounded by relatives and friends, taking many family visits and excursions to foreign countries. Although she engaged in all the domestic and social obligations and was quite popular, she felt, as early as seventeen, a desire to do something more productive and useful with her life. In between social engagements, therefore, she retreated into a private world of dreaming and writing what she later called her “private notes.” Then, in 1837, she wrote in one of her diaries that God had called her to his service, but for what she was not sure. For the next sixteen years she was tormented by this uncertainty. During these years, she unhappily continued to lead the social life that her mother prescribed, but she managed to find the time for isolated hours of self-reflection as well as visiting and nursing sick relatives.

In 1842, she learned of the work being done at the Institute of Deaconesses at Kaiserwerth, Germany, regarding the training of nurses in hospital work. For two years, she kept this knowledge to herself; then one day she tentatively voiced a desire to devote her life to nursing. Her family, especially her mother, rejected the idea completely, and for the next six years Nightingale suffered from the denial both spiritually and physically. She believed that God had called her again, yet since she was unable to follow his calling, she thought she must be somehow unworthy. The best she could do was nurse sick relatives, friends, and villagers. By 1847, she had worked herself into a state of ill health, marked by migraines, chronic coughing, and a near breakdown.

Nightingale went to Rome in 1848 to regain her spirits and health. There, she met British politician Sidney Herbert and his wife, Liz; her friendship with Sidney marked a turning point in her life. After this meeting, she rejected her long-waiting suitor Richard Monckton Milnes, disappointing her family. Now alone and desperate for an answer to God’s calling, she made her way (with the help of friends) to Kaiserwerth, Germany, but her family flatly refused to allow her to enter the school.

By that time, Nightingale was ill and suicidal; thus, she defied her family and in 1851, at the age of thirty-one, entered the questionable profession of nursing. Her rebellion did little good, however, for when she returned to England she found herself facing her mother’s anger. For the next two years she followed her mother’s will, and, periodically, nursed the sick under the guidance of the Sisters of Charity in Paris. Then, in 1853, Liz Herbert recommended Nightingale as the new superintendent at the Institution for the Care of Sick Gentlewomen in London.

Life’s Work

As superintendent of the institution for the next fourteen months, Nightingale surprised the committee that appointed her in two respects. First, the “ministering angel” they had thought that they recruited proved to be a tough-minded and practical administrator who completely reorganized the hospital, from food and beds to medical supplies and sanitary conditions. Second, Nightingale insisted that any poor and ill woman should be admitted, not only those who were members of the Church of England.

With a fight, Nightingale got most of what she wanted. She also wanted trained nurses, however, and this request was not easy to fulfill. Nightingale therefore began to formulate plans to establish a training school for nurses along the lines of Kaiserwerth. Her plans were interrupted, however, when England and France declared war on Russia in March 1854, marking the beginning of the Crimean War. War reports in the London Times stated that while England and France were victorious in battle, the casualty rate was alarmingly high.

In October 1854, Sidney Herbert asked Nightingale to lead a group of nurses to assist at the Barrack Hospital in Scutari (now Üsküdar), Turkey. She was named the superintendent of nursing at the hospital. Her initial enthusiasm for the task was soon replaced by dogged determination, for what she found in the hospital wards at Scutari was appalling. Despite assurances by the cabinet ministers in the War Office that everything was in order, Nightingale found the hospital and medical conditions deplorable. Besides a lack of basic medical supplies (bandages, splints, stretchers), nourishing food, adequate clothing, and clean water, the hospital was overrun with filth, vermin, and backed-up cesspools. In addition, the wounded, the diseased, and the dead were all crowded together in rooms with little or no ventilation. Foresight, luckily, had prompted Nightingale to bring supplies, equipment, and food with her, and while it was not nearly enough, it did help.

Lack of supplies, however, was not Nightingale’s only obstacle. Even though her position was an official one, she met with stubborn resistance from the military doctors and staff in Scutari. Slowly and steadily, however, Nightingale began her nurses on a cleanup campaign. The job was difficult, yet in time, the men in her care were cleaned, clothed, and fed, and the hospital was scrubbed and emptied (as much as possible) of the overflowing dirt. Her next task was to request the rebuilding of the Barrack Hospital; again she met with opposition, but using her own money and influence, she managed to get the men better quarters.

Nightingale’s final triumph came when the doctors (or at least most of them) relented and finally allowed her and her nurses actually to care for the patients and assist the doctors. Thus the “bird,” as she was called, became more than merely a “ministering angel”; she used her official position and her passion to serve to got things done, thus earning her title as administrative chief. Nightingale's efforts during the Crimean War were revolutionary in medical field.

The struggle was long and slow, for Nightingale was battling men who were set in their ways; they not only objected to a woman coming that close to military matters but also stubbornly refused to admit that there was any sort of problem with the medical system. However, Nightingale demanded change, and she had some powerful people on her side: Sidney Herbert, Dr. Sutherland, the Home government, the Times of London, public opinion, and Queen Victoria. Therefore, using whatever and whomever she could, Nightingale was able to reform the hospitals at Scutari, as well as some of the army’s medical policies. Within a year after her arrival in the Crimea, the rate of mortality among wounded soldiers dropped dramatically.

Nightingale not only was bent on improving the physical conditions of the men but also wanted to do something for their emotional state as well, for morale was extremely low. She set up, to the surprise and outrage of her opposition, reading and recreational rooms for the soldiers, assisted them in managing and saving some money from their salaries, and held classes and lectures for them. In the middle of all this change, she was still battling military and government officials and religious leaders who were upset by the lack of religious segregation among both the nurses and the patients. Nightingale refused, however, to let narrow-minded sectarian differences get in her way, and by July 1856, a few months after the declaration of peace, Nightingale considered her work in the Crimea complete. As she returned to England, news of her accomplishments preceded her, and the queen invited her to the court for the purpose of awarding her a brooch that bore a St. George’s cross and the royal cipher encircled in diamonds surrounded by the words “Blessed are the merciful.”

After her struggles and successes at Scutari, Nightingale’s work was far from finished: For the next fifty years, she kept fighting for hospital reform. Doctors diagnosed a nervous condition and heart trouble, telling her that if she did not take an extended rest she could die. Nightingale refused flatly and continued her work, which had become both a passion and a mission. When she was ill and tired, she read and wrote letters or reports from her bed. When she felt well enough, she visited influential people and hospitals trying to implement her reforms.

The army hospital at Scutari had been only the beginning; now Nightingale went after the Army Medical Department itself. Her supporters remained loyal and hardworking; in fact, they were joined by her Aunt Mai and Sir Harry Varney. However, she also gained two formidable enemies—Lord Panmure, the secretary of state for war, and Dr. Andrew Smith, the head of the Army Medical Department. Together, they either denied the need for reforms or managed to undermine her work. Nightingale had met resistance before, however, and their opposition did not stop her.

As in the Crimea, Nightingale used her friends, her influence, and her social position to initiate change in medical procedures, sanitary conditions, hospital design, and patient care (both physical and emotional) in England. She wrote an eight-hundred-page report, Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army (1858), and A Contribution to the Sanitary History of the British Army During the Late War with Russia (1859), which was submitted to the Royal Commission. Members of the commission received the report favorably, and as a result, drastic changes were initiated according to Nightingale’s recommendations between the years 1859 and 1861.

Nightingale was then contacted by the Sanitary Commission (an organization set up at her suggestion) and asked to investigate army medical conditions in India. By then, she had become quite a medical authority, and her reputation was spreading with the help of a published book entitled Notes on Hospitals (1859), which completely revolutionized hospital construction and administrative practices. Then, in 1860, the Nightingale Training School for Nurses at St. Thomas’s Hospital opened, and in the same year, Nightingale published Notes on Nursing: What It Is, and What It Is Not. Nightingale’s establishment of a nursing hospital earned her reputation as the founder of modern nursing. Just when it seemed Nightingale was succeeding in all of her reforms, however, disaster struck. Sidney Herbert, her most powerful ally, became ill and soon died, and with his death her open door to the world of politics shut slightly. Nevertheless, over the next ten years, from 1862 to 1872, she managed to initiate and enact many changes despite the hostility of the War Office.

By this time, however, Nightingale’s health was again causing her problems, and she settled in a house on South Street, where she remained for the rest of her life, practically bedridden. Although invalid, but she refused to be inactive and unproductive. She had a constant stream of visitors (from friends to public officials both domestic and foreign) who came seeking her advice and expertise on hospital matters. Thus, from her bed, she dictated letters, reports, and policies regarding the construction of hospitals and the training of nurses; still she wanted to do more. Having devoted her life to the physical comfort of humankind, she now turned inward to her own metaphysical condition, reading everything that she could. As in her early adult years when she wrestled with religious questions and callings, she returned to a state of spiritual and intellectual turmoil.

Nightingale’s last ten years were spent trying to satisfy unanswerable longings and questions. She became increasingly sentimental and senile. The world had all but forgotten her. In 1907, sick and confused, she received the Royal Order of Merit; she was the first woman ever to be awarded this honor. It was presented to her in her bedroom, and her only reply was, “Too kind, too kind.” Three years later, nearly blind, she died in her sleep on August 13, 1910.

Significance

Florence Nightingale has been pictured as a quiet, meek, self-sacrificing angel of mercy moving softly among dimly lit hospital corridors and beds filled with wounded soldiers. In short, she has been envisioned as the “lady of the lamp.” Although she did spend many hours comforting the sick in this manner, this is only a partial and romanticized portrait of her. What is often not realized or remembered is that Nightingale was more than a nurse; she was a hospital reformer and administrator.

Luckily for Nightingale, she was also living in a time of great change. She was not alone in her passion and determination to change the health conditions of Great Britain; others, many of them women, were also fighting for changes in laws and customs, as well as social standards and attitudes. While she crusaded for more humane medical treatment and modern facilities, others were crusading for woman suffrage, the need for welfare for the poor and sick, and a general change in attitude toward education and status.

Although not outwardly concerned with these other changes, Nightingale must have been influenced by this growing climate, which challenged the Victorian status quo. Although Nightingale’s name may remain synonymous with nursing, her impact on hospital design, construction, and administration has remained strong even into the twenty-first century.

Bibliography

Cook, Sir Edward. The Life of Florence Nightingale. 2 vols. London: Macmillan, 1913. Print.

Gill, Gillian. Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale. London: Hodder & Stoughton, 2004. Print.

Huxley, Elspeth. Florence Nightingale. New York: G. P. Putnam’s Sons, 1975. Print.

Longford, Elizabeth. Eminent Victorian Women. New York: Knopf, 1981. Print.

McDonald, Lynn, ed. Florence Nightingale: An Introduction to Her Life and Family. Vol. 1. Waterloo: Wilfrid Laurier UP, 2001. Print.

Schnittkind, Henry Thomas, and Dana Lee Thomas. Living Biographies of Famous Women. New York: Doubleday, 1959. Print.

Strachey, Lytton. Eminent Victorians. New York: Modern Library, 1918. Print.