By Major Paul Whittle
Florence Nightingale, venerated as the founder of modern nursing, was born on May 12th, 1820 and it was timely, therefore, to commemorate the 200 years since her birth with a presentation on her life and work. We were fortunate in securing the services of Paul Whittle who gave us an engrossing talk that gave us an insight into the achievements of a most remarkable women who initiated revolutionary changes in healthcare and sanitation from which we all continue to benefit. His talk was considerably enriched by vivid descriptions of the historical events that formed the backdrop to her work.
Florence Nightingale was born into a wealthy, upper class and well-connected British family at the Villa Colombaia, in Florence and was named after the city of her birth. Her older sister Frances Parthenope had similarly been named after her place of birth, Parthenope, a Greek settlement in Naples. The family moved back to England in 1821 and Florence spent her childhood in the family’s homes at Embley in Hampshire and Lea Hurst in Derbyshire. Her father, a Cambridge graduate, personally oversaw her education and through him she acquired a wide range of knowledge encompassing mathematics, science, philosophy, literature and foreign languages. She became fluent in French, German, and Italian and had a good grasp of both Latin and classical Greek.
In February 1837 she underwent the first of several recurring experiences that she believed were calls from God telling her to devote her life to the service of others. When she announced to her parents that she felt “called” to become a nurse they were far from pleased because at that time nursing was held in very low esteem as a profession. It was frequently associated with low social status and even with prostitution, drunkenness and alcoholism. Sarah Gamp, the nurse grotesquely portrayed by Dickens in Martin Chuzzlewit , offers a striking (if somewhat extreme) example of those perceptions of the profession. Although Florence was initially respectful of her family’s opposition to her vocation she was, nevertheless, a highly determined young woman and during her twenties, while travelling widely, she worked hard to educate herself in the art and science of nursing, At the same time she rebelled against the expected role for a woman of her class and status to become a wife and mother. Although receiving many offers of marriage, she remained resolutely single believing that marriage would deflect her from her main purpose in life.
In 1850, she visited a Lutheran religious community at Kaiserswerth-am-Rhein in Germany, an institute devoted to the care of the sick and deprived. She regarded this experience as a turning point in her life and here, for the first time, she received some formal medical training. Three years later, at the age of 33, she acquired her first job as superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854. By this time her father was reconciled to her choice of career and had given her an annuity of £500 (roughly £40,000 in today’s money) thus allowing her to live comfortably.
In October 1853 the Crimean War, a conflict between Russia and Britain, France and Turkey, broke out. In September 1854 the allies landed troops in Russian Crimea and began a year long siege of the fortress of Sevastopol. Very soon afterwards reports started to get got back to Britain concerning the horrific conditions suffered by the troops and their casualties. Florence was acquainted with Sydney Herbert, the UK Secretary for War, and he gave her permission to travel to treat the wounded at a field hospital at Scutari. This was sited in Turkey across the Black sea from Varna and 295 miles from Balaclava, where the main British camp was based. Florence took with her a staff of 38 women volunteer nurses that she had trained and 15 Catholic nuns. On their arrival early in November 1854 they found overworked medical staff attempting to care for wounded soldiers with inadequate medical supplies and inadequate facilities for the preparation of food. Basic hygiene was being grossly neglected resulting in mass infections and a very high mortality rate. Ten times more soldiers were dying from illnesses such as typhus, typhoid, cholera, and dysentery than from battle wounds. Officialdom appeared indifferent and initially Florence was cold shouldered by the military who shared the common low opinion of nurses.
Undaunted, Florence quickly deduced that poor sanitation was a major contributor to the high mortality rate and set about implementing strict hygiene rules. She also sent a plea to The Times for a government solution to the poor condition of the facilities calling for a Sanitary Commission to improve the sewers and ventilation. As a result of her initiatives the mortality rate was reduced from 43% in February 1855 to 2% by June. The British Government also responded by commissioning 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 had a death rate less than one tenth of that at Scutari. To address the food issue Alexis Soyer, a famous French chef , was sent to the Crimea to reorganise the provisioning of the army and its hospitals. He designed his own field stove, the Soyer Stove, and trained and installed in every regiment the “Regimental cook” so that soldiers would get an adequate meal and not suffer from malnutrition or die of food poisoning.
In addition to her efficiency and clear thinking, Florence soon became appreciated for her compassion. She would check up on the wounded long after all the medical officers had retired for the night and even wrote letters home on behalf of dying soldiers. A 1855 report in The Times which described her as a “ministering angel” making her solitary rounds “with a little lamp in her hand” won her widespread fame as the benevolent “Lady with the Lamp” and transformed her into a Victorian icon. Paul pointed out, however, that the romantic image of her bearing what he called a “Wee Willie Winkie candle” on her rounds is false. He showed a slide of her real lamp which was far more robust and practical. Sadly, Florence herself was not immune to infection. In May 1855, while visiting the hospitals at and near Balaclava with Alexis Soyer, she contracted a bacterial infection known as Crimean fever and was dangerously ill for twelve days. She never fully recovered and for the rest of her life there were often periods when she was bedridden. Early in June she returned to Scutari to resume her nursing work and to try to organise recreational facilities for the men and their families. In March 1856 she returned to Balaclava and remained there until July when the hospitals were closed. She finally returned to England in August 1856 eschewing the limelight by travelling incognito as “Miss Smith” in a French ship.
Although her actions as a young woman during the Crimean War remain her main claim to fame in the popular imagination, Paul stressed she was responsible for saving many more lives in the following 50 years of her life during which, despite her recurring bouts of ill health, she revolutionised nursing and transformed healthcare. At the end of 1855 , a public meeting had supported the establishment of a Nightingale Fund in recognition of her work in the Crimea and there had been an outpouring of generous donations. Queen Victoria was a great admirer and supporter and had rewarded Nightingale’s service by sending her a special brooch. They met in 1856 and remained in contact for decades thereafter. By the end of the decade the Nightingale Fund had amassed £45,000 and this enabled Florence to improve the training and professional status of nursing by setting up the Nightingale Training School and Home for Nurses at St Thomas’ Hospital. This opened in July 1860 and the first trained Nightingale nurses began work five years later at the Liverpool Workhouse Infirmary. This training school is now called the Florence Nightingale School of Nursing and Midwifery and is part of King’s College London. Florence also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury near her sister’s home, Claydon House.
On her return from the Crimea Florence settled in London and lived mostly the retired life of an invalid, although she remained very busy offering advice and guidance both in person and through her writing. In 1857 she issued an exhaustive report on the workings of the army medical departments in the Crimea and in 1858 she published Notes on Matters affecting the Health, Efficiency and Hospital Administration of the British Army. In 1859 her book, Notes on Nursing: What It Is and What It Is Not was published and became one of the profession’s most important texts. In all, she published over 20 influential books and reports many of which included copious statistical data in support of her theories. Although she was not the inventor of the pie chart she is recognized as being one of the earliest adopters of this effective tool for presenting data in a readily digestible form.
When the Indian Mutiny broke out in 1857 Florence offered her assistance immediately. Although her services on the ground were not required, she researched the sanitary condition of the army and civilians and her findings prompted the establishment of a Sanitary Department in the Indian government. Although she never visited India she wrote numerous papers on the causes of famine and poverty, the need for irrigation and the improvement of village sanitation. In 1858 she presented powerful evidence to a Commission investigating the sanitary condition of the army and as a result an army medical college was opened at Chatham in 1859 and the first military hospital was established in Woolwich in 1861. During the American Civil War (1861-65) both sides benefited from her advice, particularly in relation to the proper ventilation of their hospitals which were specially built in accordance with her theories. In addition she assisted the Union side in compiling soldier mortality statistics. Florence also used her considerable influence to bring about significant changes in Britain by supporting the establishment of numerous nursing societies, institutes and associations and, most notably, by successfully pushing for legislation to compel all extant buildings to connect with main drainage. This had a direct effect on extending Britain’s national life expectancy.
Florence Nightingale died in South Street, Park Lane, London, on August 13th 1910 at the age of 90 and was buried in the family plot at East Wellow, Hampshire, an offer of burial in Westminster Abbey having been refused. Memorial services took place in St. Paul’s Cathedral and Liverpool Cathedral and at many other locations. Three years before she died she had been awarded the Order of Merit, the first woman to be so honoured.
Paul concluded his talk with a fascinating illustrated tour of sites in Britain and abroad associated with Florence’s life and work drawing particular attention to the range of commemorate plaques and statues. It was gratifying to learn how she continues to be honoured one hundred and ten years after her death, not least by the celebration of her birthday around the world as “International Nurses Day”. No accolade is more richly deserved.