Lea Hurst, the summer home of the Nightingale familyFlorence Nightingale was born in 1820 to wealthy English parents traveling in Florence, Italy. Both Florence and her sister were named after the Italian cities in which they were born – her sister Parthenope was born in Naples and given the Greek name for its ancient city. At home in England, the Nightingales divided their time between two houses, Lea Hurst in Derbyshire for the summer and Embley in Hampshire for the winter. The two girls were educated by their father, and Florence, in particular, excelled academically. With regard to the marriage and social life of their daughters, the Nightingales held high expectations. However, Florence had other ideas, because as a teenager in 1837 she received a "divine calling” to do God’s work, which sparked her advocacy of social and health care causes and eventually led her to establish nursing as a distinct profession.

Pastor Theodore Fliedner, founder of the Lutheran deaconesses training center for nurses in Kaiserwerth, GermanyThe period between the later half of the 17th century and the middle of the 19th has been described by medical historian Fielding Garrison as the “dark age” of nursing. Nurses in those days were typically poor, unskilled and often associated with immoral behavior (1). The hospitals they served held equally low reputations as unclean, disorderly, and infection breeding. They were often regarded merely as places to die. So it is not difficult to see why Florence Nightingale’s family, wealthy and respectable as they were, discouraged her from selecting this “unsuitable” profession. But Florence went against her parent’s wishes, refused a prospective marriage and in 1851 trained as a nurse in Kaiserswerth, Germany at Pastor Theodore Fliedner’s hospital and school for Lutheran deaconesses. Fliedner’s school was one of the earliest institutions for the proper training of nurses outside of the Catholic religious orders (2). In 1853 Nightingale went for additional training in Paris with the Sisters of Mercy (3). After her return to England, Florence took a position as superintendent for London’s Establishment of Gentlewomen during Illness in 1853.

(Click here to view a letter written by Florence Nightingale to a Mrs. James on September 20, 1853, about patient admittance, payment, demographics and lengths of stay at London’s Establishment of Gentlewomen during Illness).

Nursing during the Crimean War

Bust of Florence Nightingale, presented to her by the soldiers after the Crimean WarFlorence Nightingale is probably most famous for her work during the Crimean War (1854-1856). Responding to unpopular newspaper reports of the horrendous situation in the English war camp hospitals, Secretary of War Sidney Herbert, a personal friend of Nightingale, consented to let her organize and manage a group of female nurses to go to Turkey. On November 4, 1854, Nightingale and 38 nurses arrived in Scutari, the location of the British camp outside Constantinople. The doctors originally did not welcome the incoming female nurses, but as the number of patients escalated, their help was needed in the overcrowded, undersupplied, and unsanitary hospital (4). Under Florence’s leadership, the nurses brought cleanliness, sanitation, nutritious food and comfort to the patients. Nightingale was known for providing the kind of personal care, like writing letters home for soldiers, that comforted them and improved their psychological health. Her group of nurses transformed the hospital into a healthy environment within six months, and as a result, the death rate of patients fell from 40 to 2 percent (5). In 1857, Florence returned home a heroine. It was the soldiers in Crimea that initially named her the "Lady with the Lamp" because of the reassuring sight of her carrying around a lamp to check on the sick and wounded during the night, and the title remained with her (6).

(Thirty-four years to the date (November 4, 1888) after she landed in Scutari for the Battle of Inkermann of the Crimean War, Florence Nightingale wrote a letter to her friend Thomas Gillham Hewlett remembering the heroic nature of soldiers. Click here to view this letter.)

Upon her return from the Crimean War, she devoted the next few years to the Royal Commission investigating health in the British Army. It was her discussions with Queen Victoria on the conditions of the camp hospitals that sparked the commission’s formation. Also, Nightingale's statistical data and analysis strongly influenced the commission's findings, which resulted in great public health advances in the British army (7).

Professional Nursing Pioneer

Title page from Notes on Nursing, the first book by Florence NightingaleIn 1859, Florence Nightingale’s book Notes on Nursing: What it is, and What it is Not was published. Based on knowledge acquired at school in Kaiserswerth and while nursing the sick during the Crimean War, Notes on Nursing provides a simple but practical discussion of good patient care, along with helpful hints. According to Florence Nightingale, hygiene, sanitation, fresh air, proper lighting, a good diet, warmth, quietness and attentiveness were necessary conditions for hospitals and were to be ensured by trained nurses. Taken for granted today, her commonsense advice helped transform hospitals from death houses to sanctuaries of care. This work quickly became a classic introduction to nursing, and has remained in publication to the present day (8).

During the war a public subscription fund was set up for Florence Nightingale to continue her education of nurses in England, and the Nightingale Training School at St. Thomas’ Hospital opened in 1860. The education of recruits involved a year of practical instruction in the wards, supplemented with courses of lecturing, and followed by two years of work experience in the hospital (9). After graduation, many of the students staffed British hospitals, and others spread the Nightingale education system to other countries.

Through her work and her school, Florence Nightingale is responsible for elevating the profession of nursing to an honorable status. She also wrote about 200 books, pamphlets and reports on hospital, sanitation, and other health-related issues, as well as contributing to the field of statistics (10). Throughout her life she provided advice on a variety of health care issues to associates all over the globe. Though ill and bedridden for much of her later life, Nightingale managed to continue her great work through correspondence.

Endnotes

1. Garrison, Fielding. An introduction to the history of medicine. 4th ed. (Philadelphia & London: W. B. Saunders, Co., 1929), 772.
2. ibid.
3. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
4. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition (http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale), Accessed May 5, 2011.
5. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
6. The Florence Nightingale Museum website (http://www.florence-nightingale.co.uk/), Accessed May 5, 2011.
7. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition (http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale), Accessed May 5, 2011.
8. ibid.
9. Tooley, Sarah A. The history of nursing in the British Empire (London: S. H. Bousfield & Co., 1906), 96.
10. The Florence Nightingale Museum website (http://www.florence-nightingale.co.uk/), Accessed May 5, 2011.