Nightingale, Florence, 1820-1910

Florence Nightingale OM RRC DStJ (/ˈnaɪtɪŋɡeɪl/; 12 May 1820 – 13 August 1910) was an English social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers at Constantinople.[4] She gave nursing a favourable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.[5][6]

Recent commentators have asserted that Nightingale's Crimean War achievements were exaggerated by the media at the time, but critics agree on the importance of her later work in professionalising nursing roles for women.[7] In 1860, she 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, and is now part of King's College London.[8] In recognition of her pioneering work in nursing, the Nightingale Pledge taken by new nurses, and the Florence Nightingale Medal, the highest international distinction a nurse can achieve, were named in her honour, and the annual International Nurses Day is celebrated on her birthday. Her social reforms included improving healthcare for all sections of British society, advocating better hunger relief in India, helping to abolish prostitution laws that were harsh for women, and expanding the acceptable forms of female participation in the workforce.

Nightingale was a pioneer in statistics; she represented her analysis in graphical forms to ease drawing conclusions and actionables from data. She is famous for usage of the polar area diagram, also called the Nightingale rose diagram, equivalent to a modern circular histogram. This diagram is still regularly used in data visualisation.

Nightingale was a prodigious and versatile writer. In her lifetime, much of her published work was concerned with spreading medical knowledge. Some of her tracts were written in simple English so that they could easily be understood by those with poor literary skills. She was also a pioneer in data visualization with the use of infographics, using graphical presentations of statistical data in an effective way.[7] Much of her writing, including her extensive work on religion and mysticism, has only been published posthumously.

Florence Nightingale was born on 12 May 1820 into a wealthy and well-connected British family at the Villa Colombaia,[9][10] in Florence, Tuscany, 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, Parthenope, 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, Hampshire, and Lea Hurst, Derbyshire.[11][12]

Florence inherited a liberal-humanitarian outlook from both sides of her family.[7] Her parents were William Edward Nightingale, born William Edward Shore (1794–1874) and Frances ("Fanny") Nightingale née Smith (1788–1880). William's mother Mary née Evans was the niece of Peter Nightingale, under the terms of whose will William inherited his estate at Lea Hurst, and assumed the name and arms of Nightingale. Fanny's father (Florence's maternal grandfather) was the abolitionist and Unitarian William Smith.[13] Nightingale's father educated her.[12] A BBC documentary states, "Florence and her older sister Parthenope benefited from their father's advanced ideas about women's education. They studied history, mathematics, Italian, classical literature, and philosophy, and from an early age Florence, who was the more academic of the two girls, displayed an extraordinary ability for collecting and analysing data which she would use to great effect in later life."[7]


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 at the military hospital on the Asiatic side of the Bosporus, opposite Constantinople, at Scutari (modern-day Üsküdar in Istanbul). Britain and France entered the war against Russia on the side of the Ottoman Empire. On 21 October 1854, she and the staff of 38 women volunteer nurses including her head nurse Eliza Roberts and her aunt Mai Smith,[22] and 15 Catholic nuns (mobilised by Henry Edward Manning)[23] were sent (under the authorisation of Sidney Herbert) to the Ottoman Empire. On the way, Nightingale was assisted in Paris by her friend Mary Clarke.[24] The volunteer nurses worked about 295 nautical miles (546 km; 339 mi) away from the main British camp across the Black Sea at Balaklava, in the Crimea.


Letter from Nightingale to Mary Mohl, 1881
Nightingale arrived at Selimiye Barracks in Scutari early in November 1854. 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.

uring the Crimean war, Nightingale gained the nickname "The Lady with the Lamp" from a phrase in a report in The Times:

In the Crimea on 29 November 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognise Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund and the 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.[citation needed]


Nightingale, c. 1858, by Goodman
Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St Thomas' Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 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. In 1866 she said the Royal Buckinghamshire Hospital in Aylesbury near her sister's home Claydon House would be "the most beautiful hospital in England", and in 1868 called it "an excellent model to follow".[42]

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".[43]

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organising the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".[44]


Illustration in Charles Dickens' Martin Chuzzlewit. Nurse Sarah Gamp (left) became a stereotype of untrained and incompetent nurses of the early Victorian era, before the reforms of Nightingale
As Mark Bostridge has demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in Britain from the 1860s onwards.[45] This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. In the first half of the 19th century, nurses were usually former servants or widows who found no other job and therefore were forced to earn their living by this work. Charles Dickens caricatured the standard of care in his 1842–1843 published novel Martin Chuzzlewit in the figure of Sarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of the Florence Nightingale Museum, "When she [Nightingale] started out there was no such thing as nursing. The Dickens character Sarah Gamp, who was more interested in drinking gin than looking after her patients, was only a mild exaggeration. Hospitals were places of last resort where the floors were laid with straw to soak up the blood. Florence transformed nursing when she got back [from Crimea]. She had access to people in high places and she used it to get things done. Florence was stubborn, opinionated, and forthright but she had to be those things in order to achieve all that she did."[46]

Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a 2008 biography disagrees,[45] saying that she was simply opposed to a precursor of germ theory known as contagionism. This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously; even afterwards, many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organising field medicine. Her ideas inspired the volunteer body of the United States Sanitary Commission.[47]


Florence Nightingale (middle) in 1886 with her graduating class of nurses from St Thomas' outside Claydon House, Buckinghamshire
In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the United States with adequate training and knowledge to establish high-quality nursing schools.[48] Richards went on to become a nursing pioneer in the US and Japan.[49]

By 1882, several Nightingale nurses had become matrons at several leading hospitals, including, in London (St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.[50]

In 1883, Nightingale became the first recipient of the Royal Red Cross. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ).[51] In 1907, she became the first woman to be awarded the Order of Merit.[52] 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.[53]

From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause.[54] 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's output slowed down considerably in her last decade. She wrote very little during that period due to blindness and declining mental abilities, though she still retained an interest in current affairs.[12]

Relationships

Florence Nightingale by Charles Staal, engraved by G. H. Mote, used in Mary Cowden Clarke's Florence Nightingale (1857)
Although much of Nightingale's work improved the lot of women everywhere, Nightingale believed that women craved sympathy and were not as capable as men.[a] She criticised early women's rights activists for decrying an alleged lack of careers for women at the same time that lucrative medical positions, under the supervision of Nightingale and others, went perpetually unfilled.[b] She preferred the friendship of powerful men, insisting they had done more than women to help her attain her goals, writing: "I have never found one woman who has altered her life by one iota for me or my opinions."[57][58] She often referred to herself in the masculine, as for example "a man of action" and "a man of business".[59]

However, she did have several important and long-lasting friendships with women. Later in life, she kept up a prolonged correspondence with Irish nun Sister Mary Clare Moore, with whom she had worked in Crimea.[60] Her most beloved confidante was Mary Clarke, an Englishwoman she met in Paris in 1837 and kept in touch with throughout her life.[61]

Some scholars of Nightingale's life believe that she remained chaste for her entire life, perhaps because she felt a religious calling to her career.[62]

Death

The grave of Florence Nightingale in the churchyard of St Margaret's Church, East Wellow, Hampshire
Florence Nightingale died peacefully in her sleep in her room at 10 South Street, Mayfair, London, on 13 August 1910, at the age of 90.[63][c] The offer of burial in Westminster Abbey was declined by her relatives and she is buried in the churchyard of St Margaret's Church in East Wellow, Hampshire, near Embley Park with a memorial with just her initials and dates of birth and death.[65][66] She left a large body of work, including several hundred notes that were previously unpublished.[67] A memorial monument to Nightingale was created in Carrara marble by Francis William Sargant in 1913 and placed in the cloister of the Basilica of Santa Croce, in Florence, Italy.[68]