Florence Nightingale

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Last Updated on May 8, 2015, by eNotes Editorial. Word Count: 3082

Article abstract: Following a deeply rooted passion to serve God and combining it with a strong will and intellect, Nightingale revolutionized the nursing profession and the design and conditions of medical care and hospital facilities.

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Early Life

On May 12, 1820, Florence Nightingale was born in and named for the romantic city of Florence, Italy. Her mother, Frances (Fanny) Nightingale, thirty-two, was a socially ambitious and strong-willed woman; her father, William Edward Nightingale, twenty-five, was a scholarly and liberal Cambridge man. Florence 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 would be a great influence on Nightingale.

As a teenager, Nightingale was surrounded by relatives and friends, family visits and excursions to foreign countries, and the usual round of social events and gossip. 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. She was expected to marry well and rear a family; still, Nightingale wanted more. In between social engagements, therefore, she would retreat 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 would be 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 1839, both Nightingale sisters were presented at court, and there Florence met Henry Nicholson, who wooed her for six years before she finally refused his marriage proposal. She could give no concrete reason other than her desire to do God’s will, whatever that was. Again, she was overwhelmed by uncertainty about what her life’s work should be, and her spells of quiet frustration and spiritual agony worried her mother. After all, Nightingale was attractive, if not beautiful, with dark reddish hair, gray eyes, a gay smile, and a sense of humor tempered with a sharp intellect and curiosity.

In 1842, another suitor presented himself: Richard Monckton Milnes, a Member of Parliament, a linguist, and a social reformer of sorts; in short, he seemed the perfect mate for Nightingale. Her feelings were nevertheless divided, for in that year 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 Florence 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.

She went to Rome in 1848 to regain her spirits and health. There, she met Sidney Herbert and his wife, Liz; her friendship with Sidney marked a turning point in her life. After this meeting, she soon rejected her long-waiting suitor Richard Milnes, again 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 then, however, 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. Again, she was plunged into the social life and for the next two years suffered as 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 made a decision on Florence’s behalf; she recommended her as the new superintendent at the Institution for the Care of Sick Gentlewomen in London. At age thirty-seven, Florence’s nursing career began in earnest.

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 to beds to medical supplies to 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, she 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. War reports in The Times stated that while England and France were victorious in battle, the casualty rate was alarmingly high. In October, Nightingale left England for the shores of the Black Sea with a handful of poorly trained nurses. As a result, she made her way into the annals of the Crimean War.

Once again, the Herberts, this time Sidney, opened the way for Nightingale by appointing her superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey, a position never before held by a woman. It was a revolutionary step, and she took it gladly. Yet her initial enthusiasm was soon replaced by dogged determination, for what she found in the hospitals at Scutari was appalling. Despite assurances by the cabinet ministers in the War Office that everything was in order, Florence 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.

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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. War and women, even if they were nurses, did not mix. Slowly and steadily, however, Nightingale began her nurses on a cleanup campaign. The job was difficult, yet in time, the men 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.

Her final triumph came when the doctors (or at least most of them) relented and finally allowed Nightingale 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,” a “lady with a lamp”; she used her official position and her passion to serve God and got things done, thus earning her title as administrative chief.

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. Yet Nightingale demanded change, and she had some powerful people on her side: Sidney Herbert, Dr. Sutherland, the Home government, The Times, public opinion, and the queen herself. 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 soldiers dropped from forty-two percent to twenty-two percent per thousand men.

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 short, she treated them like human beings. 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 which 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 she 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. Yet she also gained two formidable enemies—Lord Panmure, Secretary of State for War, and Dr. Andrew Smith, 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, so too in England she 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). 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 for her 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 men and politics shut slightly. Still, for the next ten years, 1862-1872, 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. Invalid she might be, but inactive and unproductive she was not. 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 mankind, 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, which she should have spent reveling in her accomplishments, were spent, instead, trying to satisfy unanswerable longings and questions. She became increasingly sentimental and senile. The once-thin, strong-minded woman had become a rather fat, simpleminded patient. 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.

Summary

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 with 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. Thus, although her role as nurse was a difficult task, both physically and emotionally, she also faced a more difficult task: She was a woman trying to do a man’s job in a society that, generally speaking, opposed her. 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 women’s 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. While Nightingale’s name may remain synonymous with nursing, her impact on hospital design, construction, and administration has remained strong even into the late twentieth century.

Bibliography

Cook, Sir Edward. The Life of Florence Nightingale. 2 vols. London: Macmillan, 1913. An exhaustive biography based on a comprehensive study of Nightingale’s diaries and letters, in addition to material written about her in both government and medical reports, including those from the Crimean War. The study also includes a look at Nightingale from the point of view of friends and family, based on their letters and memoirs. As a research tool, this is a valuable work.

Derieux, M. One Hundred Great Lives. London: Odham Press, 1956. A short and concise chapter which refers briefly to Nightingale’s early life, then moves on to describe the highlights of her career in the Crimea and her later work in hospital reform and nursing. Serves as a useful overview of her life and work.

Huxley, Elspeth. Florence Nightingale. New York: G.P. Putnam’s Sons, 1975. A well-written and readable biography exploring in great detail both Nightingale’s personal history and her public life. It also includes a good overview of the historical and social world in which she moved. The book is well documented by excerpts from Nightingale’s diaries and letters, as well as government publications. Huxley’s approach is both thematic and novelistic.

Longford, Elizabeth. Eminent Victorian Women. New York: Alfred A. Knopf, 1981. Longford’s chapter on Nightingale is a clear and well-written chronology of her life and accomplishments. There is some editorializing regarding Nightingale’s other biographers and her romanticized or exaggerated image. Longford’s account is marred by her cryptic references to Nightingale’s relationship with other women and her growing concern for matters intellectual and mystical.

Schnittkind, Henry Thomas, and Dana Lee Thomas. Living Biographies of Famous Women. New York: Doubleday Publishing Co., 1959. A brief and straightforward account of Nightingale’s work during and after the Crimean War. The chapter mentions, in passing, her early and later years but concentrates primarily on the highlights of her career between the years 1856 and 1862. Contains little specific information or analysis.

Strachey, Lytton. Eminent Victorians. New York: Modern Library, 1918. Strachey devotes five chapters to Nightingale in this study of famous Victorians. (She is the only woman he includes.) These well-written and well-documented chapters concentrate not only on Nightingale’s personal life and career but also on the social and political milieu in which she lived. The author’s point of view is so close to the actual time in which Florence worked that Strachey’s work has a tone and sense of familiarity with both his subject and the times.

Woodham-Smith, Cecil. Florence Nightingale, 1820-1910. New York: McGraw-Hill Book Co., 1951. Abridged ed. Lonely Crusader: The Life of Florence Nightingale. New York: McGraw-Hill Book Co., 1951. Woodham-Smith’s abridged edition concentrates primarily on Nightingale’s early life and nursing career. Although well documented, it is aimed at a young adult audience and oftentimes borders on cliché. Nightingale’s accomplishments as a hospital administrator and reformer are dealt with only briefly in the last few chapters.

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