Florence Nightingale

Florence Nightingale was an English nurse, social reformer and statistician who became famous for leading a team of nurses at the British army hospital at Scutari during the Crimean War. On her return she used her fame, her connections and her skill with numbers to push through reforms of army health, hospital design and public sanitation, and in 1860 she founded a training school that helped turn nursing into a respectable, trained profession for women. Her record in the war itself has been debated by historians, but her later influence is not seriously disputed.

Nightingale was born on 12 May 1820 in Florence, where her wealthy English parents were travelling, and was named after the city. The family returned to England the next year and divided their time between Lea Hurst in Derbyshire, Embley Park in Hampshire and London. Her father, William Nightingale, educated his two daughters himself to a high standard, teaching them classical and modern languages, history, philosophy and mathematics, a subject Florence loved.

In February 1837, aged 16, she experienced what she described as a call from God to service, though it took years to become clear that the service would be nursing. Her mother and sister opposed the idea strongly, since nursing was then a low-status job associated with poor, untrained and often drunken women. She turned down a long-standing suitor, the politician Richard Monckton Milnes, believing marriage would get in the way of her vocation. Travels in Italy, Greece and Egypt broadened her outlook, and in 1850 and again in 1851 she spent time at the Lutheran deaconess institute at Kaiserswerth on the Rhine, where she gained her first practical training. In 1853 she became superintendent of a small London hospital for sick gentlewomen in Harley Street.

In 1854 Britain and France went to war with the Russian Empire in support of the Ottoman Empire, and the main fighting took place in the Crimea. Reports in The Times described appalling conditions for wounded and sick British soldiers at the base hospital in the Selimiye Barracks at Scutari, on the Asian shore of the Bosporus opposite Istanbul. Sidney Herbert, the Secretary at War and a friend of Nightingale's, asked her to lead a party of nurses there. She arrived in early November 1854 with 38 women, among them Anglican sisters and Catholic nuns.

They found overcrowded wards, broken sewers, shortages of everything from shirts to soap, and army doctors who at first resented their presence. Nightingale used private funds, including money raised by The Times, to buy supplies, organised laundries and kitchens, and kept up a stream of complaints to London. Most deaths were caused not by wounds but by diseases such as cholera, typhus and dysentery. During the winter of 1854 to 1855 the death rate at Scutari rose to more than 40 percent of patients. It fell sharply after a government Sanitary Commission arrived in March 1855 and cleaned out the drains and improved ventilation.

The Times described her walking the wards at night with a small lamp, and the image of the Lady with the Lamp, popularised by a poem by Henry Wadsworth Longfellow, made her a national heroine. She fell seriously ill in the Crimea in 1855 and returned to England in August 1856, avoiding public celebration.

Back in Britain, Nightingale became convinced from the evidence that the high death rate at Scutari had been caused mainly by poor sanitation rather than by lack of food or overwork, a conclusion that troubled her deeply. She met Queen Victoria at Balmoral in 1856 and pressed for a royal commission on the health of the army, which was set up the following year. Working with the statistician William Farr, she analysed army mortality and showed that soldiers in peacetime barracks at home died at far higher rates than civilian men of the same age.

To make the case to ministers who would not read tables, she used graphics, most famously the polar area diagram, sometimes called the rose or coxcomb, in which wedges for each month showed deaths from disease, wounds and other causes. She did not invent the format, but she used it with great effect. In 1858 she became the first woman elected a member of the Statistical Society of London, and she was later made an honorary member of the American Statistical Association.

Public subscriptions to the Nightingale Fund, opened in 1855, allowed her to establish the Nightingale Training School at St Thomas' Hospital in London in 1860, the first secular school of its kind. It is now part of King's College London. Its graduates spread the model of trained, disciplined nurses led by trained matrons to hospitals across Britain and the British Empire, and her methods influenced nursing in the United States, where the Union consulted her during the American Civil War. Her short book Notes on Nursing, published in 1859, sold widely to ordinary households as well as to nurses. She also campaigned to bring trained nurses into workhouse infirmaries, where the sick poor had often been looked after by other inmates.

From 1857 she was often bedridden, possibly from chronic brucellosis contracted in the Crimea, but she worked from her bed for decades, writing thousands of letters and reports. She took a particular interest in India, where she studied sanitary conditions in the army and among the population and called for better irrigation, famine relief and public health, though she never went there.

Lytton Strachey's 1918 essay in Eminent Victorians, though admiring, portrayed her as a driven and demanding woman who was hard on those around her, and some contemporaries blamed her for the strain that reform work placed on Herbert, who died in 1861. Some historians, notably Hugh Small, have argued that Scutari had one of the worst death rates of any British military hospital during the war while she was there, and that she did not at first grasp the role of sanitation. Others, such as Lynn McDonald, the editor of her collected works, reply that she had no authority over the buildings or drains and that these criticisms misread the sources.

Her relationship with Mary Seacole, a Jamaican-born businesswoman and healer who ran a hotel for officers near the front, has also drawn attention. In a private letter Nightingale accused Seacole's establishment of encouraging drunkenness, and Seacole believed racial prejudice lay behind her rejection when she tried to join the nursing party. Nightingale's views on disease have sometimes been oversimplified: she long doubted contagion theories and emphasised fresh air and cleanliness, though by the 1880s she was recommending measures aimed at killing germs.

In 1883 Nightingale received the Royal Red Cross, and in 1907 she became the first woman awarded the Order of Merit. She died at her home in London on 13 August 1910, aged 90. Her family declined the offer of burial in Westminster Abbey, and she was buried in the churchyard at East Wellow in Hampshire. The Florence Nightingale Medal of the International Committee of the Red Cross is named after her, and International Nurses Day is held on her birthday, 12 May.