Florence Nightingale (/ˈnaɪtɪŋɡeɪl/; 12 May 1820 – 13 August 1910) was an Englishsocial reformer,statistician and the founder of modernnursing. Nightingale came to prominence while serving as a manager and trainer of nurses during theCrimean War, in which she organised care for wounded soldiers atConstantinople.[5] She significantly reduced death rates by improving hygiene and living standards. Nightingale gave nursing a favourable reputation and became an icon ofVictorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.[6][7]
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.[a] In 1860, she laid the foundation of professional nursing with the establishment ofher nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world and is now part ofKing's College London.[12] In recognition of her pioneering work in nursing, theNightingale Pledge taken by new nurses, and theFlorence Nightingale Medal, the highest international distinction a nurse can achieve, were named in her honour, and the annualInternational Nurses Day is celebrated on her birthday.[13] Her social reforms included improving healthcare for all sections of British society, advocating better hunger relief in India, helping toabolish prostitution laws that were harsh for women, and expanding the acceptable forms of female participation in the workforce.[14][15]
Nightingale was an innovator in statistics; she represented her analysis in graphical forms to ease drawing conclusions and actionables from data. She is famous for usage of thepolar area diagram, also called the Nightingale rose diagram, which is equivalent to a modern circularhistogram or pie chart. This diagram is still regularly used indata visualisation.[16][17]
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 insimple English so that they could easily be understood by those with poor literary skills. Much of her writing, including her extensive work on religion andmysticism, has only been published posthumously.[18]
Florence Nightingale was born on 12 May 1820 into a wealthy and well-connected British family at theVilla Colombaia,[19][20] inFlorence, Tuscany, Italy, and was named after the city of her birth. Florence's older sisterFrances Parthenope had similarly been named after her place of birth,Parthenope, aGreek settlement now part of the city ofNaples. The family moved back to England in 1821, with Nightingale being brought up in the family's homes atEmbley, Hampshire, andLea Hurst, Derbyshire.[21][22]
Florence inherited a liberal-humanitarian outlook from both sides of her family.[8] Her parents wereWilliam Edward Nightingale, born William Edward Shore (1794–1874) and Frances ("Fanny") Nightingale (née Smith; 1788–1880).[10] 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 theabolitionist andUnitarianWilliam Smith.[23] Nightingale's father educated her.[22]
"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."[8]
In 1838, her father took the family on a tour in Europe where she was introduced to the English-born Parisian hostessMary Clarke, with whom Florence bonded. She recorded that "Clarkey" was a stimulating hostess who did not care for her appearance, and that while her ideas did not always agree with those of her guests, "she was incapable of boring anyone." Her behaviour was said to be exasperating and eccentric and she had little respect for upper-class British women, whom she regarded generally as inconsequential. She said that if given the choice between being a woman or a galley slave, then she would choose the freedom of the galleys. She generally rejected female company and spent her time with male intellectuals. Clarke made an exception, however, in the case of the Nightingale family and Florence in particular. She and Florence remained close friends for 40 years despite their 27-year age difference. Clarke demonstrated that women could be equal to men, an idea that Florence had not learned from her mother.[24]
Young Florence Nightingale
Nightingale underwent the first of several experiences that she believed were calls from God in February 1837 while atEmbley Park, prompting a strong desire to devote her life to the service of others. In her youth she was respectful of her family's opposition to her working as a nurse, only announcing her decision to enter the field in 1844. Despite the anger and distress of her mother and sister, she rejected the expected role for a woman of her status to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in the face of opposition from her family and the restrictive social code for affluent young English women.[25]As a young woman, Nightingale was described as attractive, slender, and graceful. While her demeanour was often severe, she was said to be very charming and to possess a radiant smile. Her most persistent suitor was the politician and poetRichard Monckton Milnes, but after a nine-year courtship, she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.[25]
In Rome in 1847, she metSidney Herbert, a politician who had beenSecretary at War (1845–1846) who was on his honeymoon. He and Nightingale became lifelong close friends. Herbert would be Secretary of War again during theCrimean War when he and his wife would be instrumental in facilitating Nightingale's nursing work in Crimea. She became Herbert's key adviser throughout his political career, though she was accused by some of having hastened Herbert's death fromBright's disease in 1861 because of the pressure her programme of reform placed on him. Nightingale also much later had strong relations with academicBenjamin Jowett, who may have wanted to marry her.[26]
Nightingale continued her travels (now with Charles andSelina Bracebridge) as far as Greece and Egypt. While in Athens, Greece, Nightingale rescued a juvenilelittle owl from a group of children who were tormenting it, and she named the owl Athena. Nightingale often carried the owl in her pocket, until the pet died (shortly before Nightingale left for Crimea).[27]
Her writings on Egypt, in particular, are testimony to her learning, literary skill, and philosophy of life. Sailing up the Nile as far as Abu Simbel in January 1850, she wrote of theAbu Simbel temples, "Sublime in the highest style of intellectual beauty, intellect without effort, without suffering ... not a feature is correct — but the whole effect is more expressive of spiritual grandeur than anything I could have imagined. It makes the impression upon one that thousands of voices do, uniting in one unanimous simultaneous feeling of enthusiasm or emotion, which is said to overcome the strongest man."[28]
At Thebes, she wrote of being "called to God", while a week later near Cairo she wrote in her diary (as distinct from her far longer letters that her elder sister Parthenope was to print after her return): "God called me in the morning and asked me would I do good for him alone without reputation."[28] Later in 1850, she visited theLutheran religious community atKaiserswerth-am-Rhein in Germany, where she observed PastorTheodor Fliedner,Friederike Fliedner and thedeaconesses working for the sick and the deprived. She regarded the experience as a turning point in her life and issued her findings anonymously in 1851;The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work.[10] She also received four months of medical training at the institute, which formed the basis for her later care.
On 22 August 1853, Nightingale took the post of superintendent at theInstitute for the Care of Sick Gentlewomen inUpper Harley Street, London, a position she held until October 1854.[29] Her father had given her an annual income of£500 (equivalent to £59,279 in 2023), which allowed her to live comfortably and to pursue her career.[30]
Crimean War
A jewel awarded to Nightingale byQueen Victoria for her services to the soldiers in the war
Florence Nightingale's most famous contribution came during theCrimean 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 theBosporus, oppositeConstantinople, at Scutari (modern-dayÜsküdar inIstanbul). Britain and France entered the war against Russia on the side of theOttoman Empire. On 21 October 1854, she and the staff of 38 women volunteer nurses including her head nurseEliza Roberts and her aunt Mai Smith,[31] and 15 Catholic nuns (mobilised byHenry Edward Manning)[32] were sent (under the authorisation of Sidney Herbert) to the Ottoman Empire. On the way, Nightingale was assisted in Paris by her friendMary Clarke.[33] The volunteer nurses worked about 295nautical miles (546 km; 339 mi) away from the main British camp across theBlack Sea atBalaklava, in theCrimea.
Nightingale arrived atSelimiye Barracks in Scutari early in November 1854. Her team found that poor care for wounded British 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:
This frail young woman ... embraced in her solicitude the sick of three armies.
— Lucien Baudens,La guerre de Crimée, les campements, les abris, les ambulances, les hôpitaux, p. 104.[34]
After Nightingale sent a plea toThe Times for a government solution to the poor condition of the facilities, the British Government commissionedIsambard Kingdom Brunel to design aprefabricated hospital that could be built in England and shipped to theDardanelles. The result wasRenkioi Hospital, a civilian facility that, under the management ofEdmund Alexander Parkes, had a death rate less than one tenth of that of Scutari.[35]
Stephen Paget in theDictionary of National Biography asserted that Nightingale reduced the death rate from 42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary Commission.[36] For example, Nightingale implementedhandwashing in the hospital where she worked.[37]
During her first winter at Scutari, 4,077 British soldiers died there. Ten times more soldiers died from illnesses such astyphus,typhoid,cholera, anddysentery than from battle wounds. With overcrowding, defectivesewers and lack of ventilation, the Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Nightingale had arrived. The commission flushed out the sewers and improved ventilation.[38] Death rates were sharply reduced, but she never claimed credit for helping to reduce the death rate.[39][40] Head Nurse Eliza Roberts nursed Nightingale through her critical illness of May 1855.[41]
In 2001 and2008, theBBC released documentaries that were critical of Nightingale's performance in the Crimean War, as were some follow-up articles published inThe Guardian and theSunday Times.[b] Nightingale scholarLynn McDonald has dismissed these criticisms as "often preposterous", arguing they are not supported by primary sources.[22][46]
Nightingale still believed that the death rates were due to poor nutrition, lack of supplies, stale air, and overworking of the soldiers. After she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army, she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience influenced her later career when she advocated sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the army and turned her attention to the sanitary design of hospitals and the introduction of sanitation in working-class homes (seeStatistics and Sanitary Reform).[47]
According to some secondary sources, Nightingale had a frosty relationship with her fellow nurseMary Seacole, who ran a hotel/hospital for officers in the Crimea itself, many miles east of Scutari. Seacole's own memoir,Wonderful Adventures of Mrs. Seacole in Many Lands, records only one, friendly, meeting with her, when she asked her for a bed for the night and got it; Seacole was in Scutari en route to the Crimea to join her business partner and start their business. However, Seacole pointed out that when she tried to join Nightingale's group, one of Nightingale's colleagues rebuffed her, and Seacole inferred that racism was at the root of that rebuttal.[48] Nightingale told her brother-in-law, in a private letter, that she was worried about contact between her work and Seacole's business, claiming that while "she was very kind to the men and, what is more, to the Officers – and did some good (she) made many drunk".[49] Nightingale reportedly wrote, "I had the greatest difficulty in repelling Mrs. Seacole's advances, and in preventing association between her and my nurses (absolutely out of the question!) ... Anyone who employs Mrs. Seacole will introduce much kindness – also much drunkenness and improper conduct".[50] On the other hand, Seacole told the French chefAlexis Soyer that "You must know, M Soyer, that Miss Nightingale is very fond of me. When I passed through Scutari, she very kindly gave me board and lodging."
The arrival of two waves of Irish nuns, theSisters of Mercy, to assist with nursing duties at Scutari met with different responses from Nightingale.Mary Clare Moore headed the first wave and placed herself and her Sisters under the authority of Nightingale. The two were to remain friends for the rest of their lives.[51] The second wave, headed byMary Francis Bridgeman met with a cooler reception as Bridgeman refused to give up her authority over her Sisters to Nightingale while at the same time not trusting Nightingale, whom she regarded as ambitious.[52][9]
During the Crimean War, Nightingale gained the nickname "The Lady with the Lamp" from a phrase in a report inThe Times:[53]
She is a "ministering angel" without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.
— William Russell, Cited in Cook, E. T. (1913).The Life of Florence Nightingale. Vol. 1, p. 237.
Lo! in that house of misery A lady with a lamp I see Pass through the glimmering gloom, And flit from room to room.
Nightingale was nicknamed "the lady with the hammer" by the troops after using a hammer to break into locked storage to access medicine to treat the wounded. However, Russell thought the behaviour was unladylike, and invented an alternative, leading to "The Lady with the Lamp".[55][56]
Later career
In theCrimea 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 theDuke of Cambridge was chairman. In her 1856 letters she described spas in theOttoman Empire, detailing the health conditions, physical descriptions, dietary information, and other vital details of patients whom she directed there. She noted that the treatment there was significantly less expensive than in Switzerland.[57]
Nightingale had£45,000 (equivalent to £5,339,011 in 2023) at her disposal from the Nightingale Fund to set up the first nursing school, the Nightingale Training School, atSt Thomas' Hospital on 9 July 1860.[58] The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. Now called theFlorence Nightingale Faculty of Nursing and Midwifery, the school is part ofKing's College London. In 1866 she said theRoyal Buckinghamshire Hospital inAylesbury near her sister's homeClaydon House would be "the most beautiful hospital in England", and in 1868 called it "an excellent model to follow".[16]
Nightingale wroteNotes 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".[11]
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".[59]
AsMark Bostridge has demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into theworkhouse system in Britain from the 1860s onwards.[60] 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 1843–1844 published novelMartin Chuzzlewit in the figure ofSarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of theFlorence 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."[61]
Letter from Nightingale advocating for the use of salicylic acid, an antiseptic, in dressings for cancer patients, 1886[62]
Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a 2008 biography disagrees,[60] saying that she was simply opposed to a precursor of germ theory known ascontagionism. This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s byPasteur andLister, 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 theAmerican Civil War. TheUnion government approached her for advice on organising field medicine. Her ideas inspired the volunteer body of theUnited States Sanitary Commission.[63]
Nightingale advocated autonomous nursing leadership, and that her new style of matrons had full control and discipline over their nursing staff.[64] The infamous "Guy's Hospital dispute" in 1879–1880 between matron Margaret Burt and hospital medical staff highlighted how doctors sometimes felt that their authority was being challenged by these new style Nightingale matrons.[65] This was not an isolated episode and other matrons experienced similar issues, such asEva Luckes.[66]
In the 1870s, Nightingale mentoredLinda 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.[67] Richards went on to become a nursing pioneer in the US and Japan.[68] In 1873,Elizabeth Christophers Hobson co-founded theBellevue Training School for Nurses in New York, setting the trend for nursing training practices in the US according to the Nightingale plan.[69]
From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography citesbrucellosis and associatedspondylitis as the cause.[60] 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. From home, she was able to select and purchaseflannel viamail order, a then-new method of retail conceived by Welsh entrepreneurPryce Pryce-Jones, who would use Nightingale's name as a customer in his advertising.[75][76] 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.[22]
Relationships
Although much of Nightingale's work improved the lot of women everywhere, Nightingale believed that women cravedsympathy and were not as capable as men.[d] 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.[e] 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."[79][80] She often referred to herself as, for example, "a man of action" and "a man of business".[81]
However, she did have several important and long-lasting friendships with women. Later in life, she kept up a prolonged correspondence with Irish nunMary Clare Moore, with whom she had worked in Crimea.[82] Her most beloved confidante was Mary Clarke, an Englishwoman she met in Paris in 1837 and kept in touch with throughout her life.[83] She was friends with pioneering computer programmerAda Lovelace, and upon Lovelace's death from cancer at 36 in 1852 after several months of pain, Nightingale wrote, "They said she could not possibly have lived so long, were it not for the tremendous vitality of the brain, that would not die".[84]
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.[85]
Death
Nightingale's grave 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.[86][f] The offer of burial inWestminster Abbey was declined by her relatives and she is buried in the churchyard of St Margaret's Church inEast Wellow, Hampshire, near Embley Park with a memorial with just her initials and dates of birth and death.[88][89] She left a large body of work, including several hundred notes that were previously unpublished.[90] A monument to Nightingale was created inCarrara marble by Francis William Sargant in 1913 and placed in the cloister of theBasilica of Santa Croce, in Florence, Italy.[91]
Contributions
Statistics and sanitary reform
Florence Nightingale exhibited a gift for mathematics from an early age and excelled in the subject under the tutelage of her father.[g] Later, Nightingale became a pioneer in the visual presentation of information andstatistical graphics.[93] She used methods such as thepie chart, which had first been developed byWilliam Playfair in 1801.[94] While common now, it was at the time a relatively novel method of presenting data.[95]
Indeed, Nightingale is described as "a true pioneer in the graphical representation of statistics" and is especially well known for her usage of apolar area diagram,[95]: 107 or occasionally theNightingale rose diagram, equivalent to a modern circularhistogram, to illustrate seasonal sources of patient mortality in the military field hospital she managed. While frequently credited as the creator of the polar area diagram, it is known to have been used by André-Michel Guerry in 1829[96] and Léon Louis Lalanne by 1830.[97] Nightingale called a compilation of such diagrams a "coxcomb", but later that term would frequently be used for the individual diagrams.[98] She made extensive use of coxcombs to present reports on the nature and magnitude of the conditions of medical care in the Crimean War toMembers of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports. In 1859, Nightingale was elected the first female member of theRoyal Statistical Society.[99] In 1874 she became an honorary member of theAmerican Statistical Association.[100]
Her attention turned to the health of the British Army inIndia and she demonstrated that bad drainage, contaminated water, overcrowding, and poor ventilation were causing the high death rate.[101] Following the reportThe Royal Commission on India (1858–1863), which included drawings done by her cousin, artistHilary Bonham Carter, with whom Nightingale had lived,[h] Nightingale concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.[8]
Nightingale made a comprehensive statistical study ofsanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health services in India. In 1858 and 1859, she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later, she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".[95]: 107
The Royal Sanitary Commission of 1868–1869 presented Nightingale with an opportunity to press for compulsory sanitation in private houses. She lobbied the minister responsible,James Stansfeld, to strengthen the proposed Public Health Bill to require owners of existing properties to pay for connection to mains drainage.[103] The strengthened legislation was enacted in the Public Health Acts of 1874 and 1875. At the same time, she combined with the retired sanitary reformerEdwin Chadwick to persuade Stansfeld to devolve powers to enforce the law to local authorities, eliminating central control by medical technocrats.[104] Her Crimean War statistics had convinced her that non-medical approaches were more effective given the state of knowledge at the time. Historians now believe that both drainage and devolved enforcement played a crucial role in increasing average national life expectancy by 20 years between 1871 and the mid-1930s during which time medical science made no impact on the most fatal epidemic diseases.[39][40][105]
Nightingale's achievements are all the more impressive when they are considered against the background of social restraints on women in Victorian England. Her father, William Edward Nightingale, was an extremely wealthy landowner, and the family moved in the highest circles of English society. In those days, women of Nightingale's class did not attend universities and did not pursue professional careers; their purpose in life was to marry and bear children. Nightingale was fortunate. Her father believed women should be educated, and he personally taught her Italian, Latin, Greek, philosophy, history, and – most unusual of all for women of the time – writing and mathematics.[95]: 98
Lytton Strachey was famous for his book debunking 19th-century heroes,Eminent Victorians (1918). Nightingale gets a full chapter, but instead of debunking her, Strachey praised her in a way that raised her national reputation and made her an icon for English feminists of the 1920s and 1930s.[106]
While better known for her contributions in the nursing and mathematical fields, Nightingale was also an important link in the study of Englishfeminism. She wrote some 200 books, pamphlets and articles throughout her life.[61] During 1850 and 1852, she was struggling with her self-definition and the expectations of an upper-class marriage from her family. As she sorted out her thoughts, she wroteSuggestions for Thought to Searchers after Religious Truth. This was an 829-page, three-volume work, which Nightingale had printed privately in 1860, but which until recently was never published in its entirety.[107] An effort to correct this was made with a 2008 publication byWilfrid Laurier University, as volume 11[108] of a 16 volume project, theCollected Works of Florence Nightingale.[109] The best known of these essays, called "Cassandra", was previously published byRay Strachey in 1928. Strachey included it inThe Cause, a history of the women's movement. Apparently, the writing served its original purpose of sorting out thoughts; Nightingale left soon after to train at the Institute for deaconesses atKaiserswerth.
"Cassandra" protests the over-feminisation of women into near helplessness, such as Nightingale saw in her mother's and older sister's lethargic lifestyle, despite their education. She rejected their life of thoughtless comfort for the world of social service. The work also reflects her fear of her ideas being ineffective, as wereCassandra's. Cassandra was a princess ofTroy who served as a priestess in the temple ofApollo during theTrojan War. The god gave her the gift ofprophecy; when she refused his advances, he cursed her so that her prophetic warnings would go unheeded.Elaine Showalter called Nightingale's writing "a major text of English feminism, a link betweenWollstonecraft andWoolf".[110] Nightingale was initially reluctant to join the Women'sSuffrage Society when asked byJohn Stuart Mill, but throughJosephine Butler was convinced 'that women's enfranchisement is absolutely essential to a nation if moral and social progress is to be made'.[111]
In 1972, the poetEleanor Ross Taylor wrote "Welcome Eumenides", a poem written in Nightingale's voice and quoting frequently from Nightingale's writings.[112]Adrienne Rich wrote that "Eleanor Taylor has brought together the waste of women in society and the waste of men in wars and twisted them inseparably."[113]
Theology
Despite being named as a Unitarian in several older sources, Nightingale's own rare references to conventional Unitarianism are mildly negative. She remained in theChurch of England throughout her life, albeit with unorthodox views. Influenced from an early age by theWesleyan tradition,[i] Nightingale felt that genuine religion should manifest in active care and love for others.[j] She wrote a work of theology:Suggestions for Thought, her owntheodicy, which develops herheterodox ideas. Nightingale questioned the goodness of a God who would condemn souls to hell and was a believer inuniversal reconciliation – the concept that even those who die without being saved will eventually make it to heaven.[k] She would sometimes comfort those in her care with this view. For example, a dying young prostitute being tended by Nightingale was concerned she was going to hell and said to her "Pray God, that you may never be in the despair I am in at this time". The nurse replied "Oh, my girl, are you not now more merciful than the God you think you are going to? Yet the real God is far more merciful than any human creature ever was or can ever imagine."[21][80][l][m]
Despite her intense personal devotion to Christ, Nightingale believed for much of her life that the pagan and eastern religions had also contained genuine revelation. She was a strong opponent of discrimination both against Christians of different denominations and against those of non-Christian religions. Nightingale believed religion helped provide people with the fortitude for arduous good work and would ensure the nurses in her care attended religious services. However, she was often critical of organised religion. She disliked the role the 19th century Church of England would sometimes play in worsening the oppression of the poor. Nightingale argued that secular hospitals usually provided better care than their religious counterparts. While she held that the ideal health professional should be inspired by a religious as well as professional motive, she said that in practice many religiously motivated health workers were concerned chiefly in securing their own salvation and that this motivation was inferior to the professional desire to deliver the best possible care.[21][80]
Nightingale's lasting contribution has been her role in founding the modern nursing profession.[118] She set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. The first official nurses' training programme, herNightingale School for Nurses, opened in 1860 and is now called the Florence Nightingale Faculty of Nursing and Midwifery atKing's College London.[119]
She belongs to that select band of historical characters who are instantly recognisable: the Lady with the Lamp, ministering to the wounded and dying.
In 1912, theInternational Committee of the Red Cross instituted theFlorence Nightingale Medal, which is awarded every two years to nurses or nursing aides for outstanding service.[13] It is the highest international distinction a nurse can achieve and is awarded to nurses or nursing aides for "exceptional courage and devotion to the wounded, sick or disabled or to civilian victims of a conflict or disaster" or "exemplary services or a creative and pioneering spirit in the areas of public health or nursing education".[120] Since 1965,International Nurses Day has been celebrated on her birthday (12 May) each year.[121] ThePresident of India honours nursing professionals with the "National Florence Nightingale Award" every year on International Nurses Day.[122] The award, established in 1973, is given in recognition of meritorious services of nursing professionals characterised by devotion, sincerity, dedication and compassion.[122]
TheNightingale Pledge is a modified version of theHippocratic Oath which nurses in the United States recite at theirpinning ceremony at the end of training. Created in 1893 and named after Nightingale as the founder of modern nursing, the pledge is a statement of the ethics and principles of the nursing profession.[123]
The Florence Nightingale Declaration Campaign,[124] established by nursing leaders throughout the world through the Nightingale Initiative for Global Health (NIGH), aims to build a global grassroots movement to achieve twoUnited Nations Resolutions for adoption by the UN General Assembly of 2008. They will declare: The International Year of the Nurse–2010 (the centenary of Nightingale's death); The UN Decade for a Healthy World – 2011 to 2020 (the bicentenary of Nightingale's birth). NIGH also works to rekindle awareness about the important issues highlighted by Florence Nightingale, such as preventive medicine and holistic health. As of 2016, the Florence Nightingale Declaration has been signed by over 25,000 signatories from 106 countries.[125]
During theVietnam War, Nightingale inspired manyUS Army nurses, sparking a renewal of interest in her life and work. Her admirers includeCountry Joe ofCountry Joe and the Fish, who has assembled an extensive website in her honour.[126] The Agostino Gemelli Medical School[127] in Rome, the first university-based hospital in Italy and one of its most respected medical centres, honoured Nightingale's contribution to the nursing profession by giving the name "Bedside Florence" to a wireless computer system it developed to assist nursing.[128]
Hospitals
Four hospitals in Istanbul are named after Nightingale: Florence Nightingale Hospital inŞişli (the biggest private hospital in Turkey), Metropolitan Florence Nightingale Hospital in Gayrettepe, European Florence Nightingale Hospital inMecidiyeköy, and Florence Nightingale Hospital inKadıköy, all belonging to the Turkish Cardiology Foundation.[129]
In 2011, an appeal was made for the formerDerbyshire Royal Infirmary hospital in Derby, England to be named after Nightingale. It was suggested the name could be either Nightingale Community Hospital or Florence Nightingale Community Hospital. The area where the hospital is situated is sometimes referred to as the "Nightingale Quarter".[130]
During theCOVID-19 pandemic, a number of temporaryNHS Nightingale Hospitals were set up in readiness for an expected rise in the number of patients needing critical care. The first was housed in theExCeL London[131] and several others followed across England.[132] Celebrations to mark her bicentenary in 2020, were disrupted by the coronavirus pandemic and Nightingale's contribution to scientific and statistical analysis of infectious disease and nursing practice may have led to the new temporary hospitals being in her name, in Scotland named theNHS Louisa Jordan after a nurse who followed in Nightingale's footsteps in battlefield nursing inWorld War One.[133]
A statue of Florence Nightingale by the 20th-century war memorialistArthur George Walker stands inWaterloo Place,Westminster, London, just offThe Mall. There are three statues of Nightingale in Derby – one outside theDerbyshire Royal Infirmary (DRI), one in St Peter's Street, and one above the Nightingale-Macmillan Continuing Care Unit opposite the Derbyshire Royal Infirmary. Apub named after her stands close to the DRI.[134] The Nightingale-Macmillan continuing care unit is now at theRoyal Derby Hospital, formerly known as The City Hospital, Derby.[135]
Astained glass window was commissioned for inclusion in the DRI chapel in the late 1950s. When the chapel was demolished the window was removed and installed in the replacement chapel. At the closure of the DRI, the window was again removed and stored. In October 2010,£6,000 (equivalent to £9,717 in 2023) was raised to reposition the window inSt Peter's Church, Derby. The work features nine panels, of the original ten, depicting scenes of hospital life, Derby townscapes, and Nightingale herself. Some of the work was damaged and the tenth panel was dismantled for the glass to be used in the repair of the remaining panels. All the figures, who are said to be modelled on prominent Derby town figures of the early sixties, surround and praise a central pane of the triumphant Christ. A nurse who posed for the top right panel in 1959 attended the rededication service in October 2010.[136]
Upon the centenary of Nightingale's death in 2010, and to commemorate her connection withMalvern, theMalvern Museum held a Florence Nightingale exhibit[139] with a school poster competition to promote some events.[140]
In Istanbul, the northernmost tower of the Selimiye Barracks building is now the Florence Nightingale Museum.[141] and in several of its rooms, relics and reproductions related to Florence Nightingale and her nurses are on exhibition.[142]
When Nightingale moved on to the Crimea itself in May 1855, she often travelled on horseback to make hospital inspections. She later transferred to a mule cart and was reported to have escaped serious injury when the cart was toppled in an accident. Following this, she used a solid Russian-built black carriage, with a waterproof hood and curtains. The carriage was returned to England by Alexis Soyer after the war and subsequently given to the Nightingale training school. The carriage was damaged when the hospital was bombed during the Second World War. It was restored and transferred to Claydon House and is now displayed at theArmy Medical Services Museum inMytchett, Surrey, nearAldershot.[143]
A bronze plaque, attached to the plinth of the Crimean Memorial in theHaydarpaşa Cemetery, Istanbul, Turkey and unveiled onEmpire Day, 1954, to celebrate the 100th anniversary of her nursing service in that region, bears the inscription: "To Florence Nightingale, whose work near this Cemetery a century ago relieved much human suffering and laid the foundations for the nursing profession."[144] Other monuments of Nightingale include a statue atChiba University in Japan, a bust atTarlac State University in the Philippines, and a bust atGun Hill Park in Aldershot in the UK. Other nursing schools around the world are named after Nightingale, such as inAnápolis in Brazil.[145]
When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life. God bless my dear old comrades of Balaclava and bring them safe to shore. Florence Nightingale.[146]
Theatre
The first theatrical representation of Nightingale wasReginald Berkeley'sThe Lady with the Lamp, premiering in London in 1929 withEdith Evans in the title role. It did not portray her as an entirely sympathetic character and draws much characterisation fromLytton Strachey's biography of her inEminent Victorians.[147]
In 2009, a stage musical play representation of Nightingale entitledThe Voyage of the Lass was produced by the Association of Nursing Service Administrators of thePhilippines. In 2019,Nightingale, a stage musical produced by Pamela Gerke and directed by Rachel Rene, was performed in Seattle, Washington.[148]
Portrayals of Nightingale on television, in documentary as in fiction, vary – the BBC's 2008Florence Nightingale, featuringLaura Fraser,[152] emphasised her independence and feeling of religious calling, but in Channel 4's 2006Mary Seacole: The Real Angel of the Crimea, she is portrayed as narrow-minded and opposed toMary Seacole's efforts.[153]
The centenary of Nightingale's death in 2010 was commemorated with a£2 coin issued by theRoyal Mint showing her taking a patient's pulse.[158]
Photographs
Nightingale had a principled objection to having photographs taken or her portrait painted. An extremely rare photograph of her, in May 1858 by William Slater, was discovered in 2006 and is now at theFlorence Nightingale Museum in London.[160] The photo shows her reading outside her family home in Embley Park, Hampshire.[161]
A black-and-white photograph taken in about 1907 byLizzie Caswall Smith at Nightingale's London home in South Street, Mayfair, was auctioned on 19 November 2008 by Dreweatts auction house inNewbury, Berkshire, England, for£5,500 (equivalent to £9,270 in 2023), which is the last currently-known photo of her.[162] The picture shows her in Claydon House, Buckinghamshire.[163]
Biographies
The first biography of Nightingale was published in England in 1855. In 1911,Edward Tyas Cook was authorised by Nightingale's executors to write the official life, published in two volumes in 1913. Nightingale was also the subject of one of Lytton Strachey's four mercilessly provocative biographical essays,Eminent Victorians. Strachey regarded Nightingale as an intense, driven woman who was both personally intolerable and admirable in her achievements.[164]
Cecil Woodham-Smith, like Strachey, relied heavily on Cook'sLife in her 1950 biography, though she did have access to new family material preserved at Claydon. In 2008, Mark Bostridge published a major new life of Nightingale, almost exclusively based on unpublished material from the Verney Collections at Claydon and from archival documents from about 200 archives around the world, some of which had been published by Lynn McDonald in her sixteen-volume edition of theCollected Works of Florence Nightingale (2001—2012).[8]
Washington National Cathedral celebrates Nightingale's accomplishments with a double-lancet stained glass window featuring six scenes from her life, designed by artist Joseph G. Reynolds and installed in 1983.[169]
In 1981, the asteroid3122 Florence was named after her.[172] A DutchKLMMcDonnell-Douglas MD-11 (registration PH-KCD) was also named in her honour; it served the airline for 20 years, from 1994 to 2014.[173] Nightingale has appeared on international postage stamps, including, the UK,Alderney, Australia, Belgium, Dominica, Hungary (showing the Florence Nightingale medal awarded by the International Red Cross), and Germany.[10]
Nightingale, Florence (2003). Vallee, Gerard (ed.).Mysticism and Eastern Religions. Collected Works of Florence Nightingale. Vol. 4. Ontario, Canada: Wilfrid Laurier University Press.ISBN978-0-88920-413-3.Archived from the original on 10 March 2021. Retrieved6 July 2010 – viaGoogle Books.
Nightingale, Florence (2008). McDonald, Lynn (ed.).Suggestions for Thought. Collected Works of Florence Nightingale. Vol. 11. Ontario, Canada: Wilfrid Laurier University Press.ISBN978-0-88920-465-2.Archived from the original on 10 March 2021. Retrieved6 July 2010 – viaGoogle Books.
^The original painting was created in 1854; the date 1891 refers to the widely circulated lithograph version.
^In an 1861 letter Nightingale wrote, "Women have no sympathy. ... Women crave for being loved, not for loving. They scream out at you for sympathy all day long, they are incapable of giving any in return, for they cannot remember your affairs long enough to do so. ... They cannot state a fact accurately to another, nor can that other attend to it accurately enough for it to become information."[77]
^In the same 1861 letter she wrote, "It makes me mad, the Women's Rights talk about 'the want of a field' for them – when I would gladly give £500 a year for a Woman secretary. And two English Lady superintendents have told me the same thing. And we can't getone ..."[78]
^Florence Nightingale, the famous nurse of the Crimean war and the only woman who ever received the Order of Merit, died yesterday afternoon at her London home. Although she had been an invalid for a long time, rarely leaving her room, where she passed the time in a half-recumbent position and was under the constant care of a physician, her death was somewhat unexpected. A week ago she was quite sick, but then improved and on Friday was cheerful. During that night alarming symptoms developed and she gradually sank until 2 o'clock Saturday afternoon, when the end came. —New York Times (15 Aug 1910)[87]
^There were rumours that she was tutored by an eminent mathematician who was a friend of the family. Mark Bostridge says, "There appears to be no documentary evidence to connect Florence withJ. J. Sylvester."[92]
^[many letters were written by Nightingale to her cousin Hilary Bonham-Carter] ... Royal Commission on India (1858–1863) ... feeling that her cousin was neglecting her art, [Nightingale] made Hilary Bonham Carter leave ... the Indian embroidery belonged to dear Hilary ...[102]
^Her parents took their daughters to both Church of England and Methodist churches.[114]
^Nightingale's rare references to Unitarianism are mildly negative, and while her religious views were heterodox, she remained in the Church of England throughout her life. Her biblical annotations, private journal notes, and translations of the mystics give quite a different impression of her beliefs, and these do have a bearing on her work with nurses, and not only at Edinburgh, but neither [Cecil(ia) Woodham-]Smith nor [her] followers consulted their sources."[115]
^"Certainly the worst man would hardly torture his enemy, if he could, forever. Unless God has a scheme that every man is to be saved forever, it is hard to say in what He is not worse than man. For all good men would save others if they could."[116]
^Although not formally a Universalist by church membership, she had come of a Universalist family, was sympathetic to the tenets of the denomination, and has always been claimed by it.[117]
^Buhnemann, Kristin (17 February 2020)."Florence Nightingale's Voice, 1890".florence-nightingale.co.uk. Florence Nightingale Museum London. Archived fromthe original on 12 April 2020. Retrieved7 April 2022.
^Strachey, Lytton (1918).Eminent Victorians. London: Chatto and Windus. p. 123.
^abNightingale, Florence (1974) [1859]. "Preface".Notes on Nursing: What it is and what it is not. Glasgow and London: Blackie & Son.ISBN978-0-216-89974-2.
^Petroni, A (1969). "The first nursing school in the world – St. Thomas Hospital School in London".Munca Sanit.17 (8):449–454.PMID5195090.
^abcNightingale, Florence (2003). "Introduction,passim". In Vallee, Gerard (ed.).Florence Nightingale on Mysticism and Eastern Religions. Collected Works of Florence Nightingale. Vol. 4.Wilfrid Laurier University Press.ISBN978-0-88920-413-3.
^abcdNightingale, Florence (2010). "An introduction to volume 14". In McDonald, Lynn (ed.).Florence Nightingale: The Crimean War. Collected Works of Florence Nightingale. Vol. 14.Wilfrid Laurier University Press.ISBN978-0-88920-469-0.
^abChaney, Edward (2006). "Egypt in England and America: The Cultural Memorials of Religion, Royalty and Revolution". In Ascari, M.; Corrado, A. (eds.).Sites of Exchange European Crossroads and Faultlines. Amsterdam and New York: Rodopi. pp. 39–74.
^"History of Harley Street".Harley Street Guide.Archived from the original on 7 November 2017. Retrieved9 November 2009. (commercial website)
^Mary Jo Weaver (1985).New Catholic Women: a Contemporary Challenge to Traditional Religious Authority. San Francisco: Harper and Row. p. 31. citingHartley, Olga (1935).Women and the Catholic Church. London: Buns, Oates & Washbourne. pp. 222–223.
^Patrick Waddington (January 2007) [first published 2004]."Mohl, Mary Elizabeth (1793–1883)".Oxford Dictionary of National Biography (online ed.). Oxford University Press. Accessed 7 February 2015.
^"History". The Global Handwashing Partnership. 19 March 2015.Archived from the original on 18 April 2015. Retrieved18 April 2015.
^Nightingale, Florence (1999).Florence Nightingale: Measuring Hospital Care Outcomes. Joint Commission on Accreditation of Healthcare Organizations.ISBN978-0-86688-559-1.
^abNightingale, Florence (1914).Florence Nightingale to Her Nurses: A Selection From Miss Nightingale's Addresses to Probationers and Nurses of the Nightingale School at St Thomas's Hospital. London: Macmillan.
^McDonald, Lynn, ed.Florence Nightingale: The Crimean War in Collected Works. vol. xiv, 2010, pp. 65, 384 & 1038
^Chang, Tan-Feng (Fall 2017). "Creolizing the White Woman's Burden: Mary Seacole Playing "Mother" at the Colonial Crossroads Between Panama and Crimea".College Literature.44 (4). Johns Hopkins University Press:527–557.doi:10.1353/lit.2017.0033.ISSN1542-4286.JSTOR48553646.
^Bridgeman, M. F. (1854–1856). "An Account of the Mission of the Sisters of Mercy in the Military Hospitals of the East, Beginning December 1854 and Ending May 1856". Unpublished manuscript, Archives of the Sisters of Mercy, Dublin, p. 18
^Longfellow, Henry Wadsworth (November 1857)."Santa Filomena".The Atlantic Monthly. pp. 22–23.Archived from the original on 14 May 2008. Retrieved13 March 2010.
^Nightingale, Florence (1974) [1859]. "Introduction by Joan Quixley".Notes on Nursing: What it is and what it is not. Blackie & Son.ISBN978-0-216-89974-2.
^abcMark Bostridge (2008).Florence Nightingale, the Woman and her Legend. Viking.
^"The Sanitary Commission—The Red Cross". Cambridge University Press. JSTOR. 1910.JSTOR2186240.
^Vicinus, Martha (1985).Independent Women, Work and Community for Single Women, 1850–1920. London: The University of Chicago Press. p. 109.
^Waddington, Keir (1995).'The Nursing Dispute at Guy's Hospital, 1879–1880'. The Journal of The Society for The Social History of Medicine. pp. 211–230.
^Collected Works of Florence Nightingale, Vol. 13: Extending Nursing. Vol. 13. Wilfrid Laurier University Press. 2012.
^Role Development for Doctoral Advanced Nursing Practice. Springer Publishing Company. 15 December 2010. p. 325.
^Vojnovic, Paola (2013).'Florence Nightingale: The Lady of the Lamp' inSanta Croce in Pink: Untold Stories of Women and their Monuments. Adriano Antonioletti Boratto. p. 27.
^Friendly, Michael (2007). "A.-M. Guerry's Moral Statistics of France: Challenges for Multivariable Spatial Analysis".Statistical Science.22 (3). Institute of Mathematical Statistics.arXiv:0801.4263.doi:10.1214/07-STS241.S2CID13536171.
^"About us".Royal Statistical Society.Archived from the original on 27 October 2017. Retrieved26 October 2017.
^Norman L. Johnson, Samuel Kotz (2011). Leading Personalities in Statistical Sciences: From the Seventeenth Century to the Present". p. 314. John Wiley & Sons.
^Professional Nursing Practice: Concepts and perspective, Koernig & Hayes, sixth edition, 2011, p. 100.
^Nightingale, Florence (2008) [1860]. McDonald, Lynn (ed.).Suggestions for Thought. Collected Works of Florence Nightingale. Vol. 11. Ontario, Canada: Wilfrid Laurier University Press.ISBN978-0-88920-465-2.Archived from the original on 10 March 2021. Retrieved6 July 2010.
^Gilbert, Sandra M., and Susan Gubar. "Florence Nightingale".The Norton Anthology of Literature by Women: The Traditions in English. New York: W. W. Norton, 1996. 836–837.
^Crathern, Alice Tarbell (1953)."For the Sick".In Detroit Courage Was the Fashion: The Contribution of Women to the Development of Detroit from 1701 to 1951. Wayne University Press. pp. 80–81.ISBN9780598268259.Archived from the original on 10 March 2021. Retrieved2 August 2018.{{cite book}}:ISBN / Date incompatibility (help)
^O'Brien, Mary Elizabeth (25 October 2010).Servant Leadership in Nursing: Spirituality and Practice in Contemporary Health Care. Jones & Bartlett Publishers. p. 333.
Bostridge, Mark (2008),Florence Nightingale: The Woman and Her Legend. Viking (2008), Penguin (2009). US titleFlorence Nightingale: The Making of an Icon. New York: Farrar, Straus and Giroux (2008).
Bullough, Vern L.;Bullough, Bonnie; and Stanton, Marieta P.,Florence Nightingale and Her Era: A Collection of New Scholarship, New York, Garland, 1990.
Chaney, Edward (2006), "Egypt in England and America: The Cultural Memorials of Religion, Royalty and Revolution," inSites of Exchange: European Crossroads and Faultlines, eds. Ascari, Maurizio, and Corrado, Adriana. Rodopi BV, Amsterdam and New York, 39–74.
Gill, Gillian (2004).Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale. Ballantine Books.ISBN978-0-345-45187-3
Magnello, M. Eileen. "Victorian statistical graphics and the iconography of Florence Nightingale's polar area graph,"BSHM Bulletin: Journal of the British Society for the History of Mathematics (2012) 27#1 pp 13–37
Nelson, Sioban, andRafferty, Anne Marie, eds.Notes on Nightingale: The Influence and Legacy of a Nursing Icon (Cornell University Press; 2010) 184 pages. Essays on Nightingale's work in the Crimea and Britain's colonies, her links to the evolving science of statistics, and debates over her legacy and historical reputation and persona.
Parton, James (1868). "Florence Nightingale," inEminent Women of the Age; Being Narratives of the Lives and Deeds of the Most Prominent Women of the Present Generation, Hartford, Conn.: S. M. Betts & Company.
Pugh, Martin,The March of the Women: A Revisionist Analysis of the Campaign for Women's Suffrage, 1866–1914, Oxford (2000), at 55.
Richards, Linda (2006).America's First Trained Nurse: My Life as a Nurse in America, Great Britain and Japan 1872–1911. Diggory Press.ISBN978-1-84685-068-4.
Sokoloff, Nancy Boyd,Three Victorian Women Who Changed their World: Josephine Butler, Octavia Hill, Florence Nightingale, London: MacMillan (1982).
Florence Nightingale Collection atWayne State University Library consists primarily of letters written by Florence Nightingale throughout her life. Major topics of the letters include medical care for the soldiers and the poor, the role of nursing, and sanitation and public works in colonized India.
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