Florence Nightingale

Florence Nightingale
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Born
12 May 1820 Florence, Italy
Died
13 August 1910 London, England

Florence Nightingale, OM (12 May 1820 – 13 August 1910), who came to be known as The Lady with the Lamp, was a pioneer of modern nursing. She was also a noted statistician.

Early life

Florence Nightingale was born into a wealthy and well-connected British family at the Villa Colombaia in Florence, Italy. She was named after the city of her birth, as was her older sister (named Parthenope, the Greek name for the city of Naples).

Inspired by what she understood to be a divine calling (first experienced in 1837 at the age of 17 at Embley Park and later throughout her life), Nightingale made a commitment to nursing. This decision demonstrated a strong will on her part; it constituted a rebellion against the expected role for a woman of her status, which was to become an obedient wife. At the time, nursing was a career with a poor reputation, filled mostly by poorer women, "hangers-on" who followed the armies; they were equally likely to function as cooks. Nightingale would announce her decision to enter nursing to her family in 1845, evoking intense anger and distress from her family, particularly her mother.

Nightingale was particularly concerned with the appalling conditions of medical care for the legions of the poor and indigent. In December 1844, in response to a pauper's death in a workhouse infirmary in London that became a public scandal, she became the leading advocate for improved medical care in the infirmaries and immediately engaged the support of Charles Villiers, then president of the Poor Law Board. This led to her active role in the reform of the Poor Laws, extending far beyond the provision of medical care.

In 1846 she visited Kaiserswerth, Germany, and learned more of its pioneering hospital established by Theodor Fliedner and managed by an order of Lutheran deaconesses. She was greatly impressed by the quality of medical care and by the commitment and practices of the deaconesses.

Nightingale was courted by politician and poet Richard Monckton Milnes, 1st Baron Houghton, but she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing. When in Rome in 1847, recovering from a mental breakdown precipitated by a continuing crisis of her relationship with Milnes, she met Sidney Herbert, a brilliant politician who had been Secretary at War (1845 – 1846), a position he would hold again (1852 – 1854) during the Crimean War. Herbert was already married, but he and Nightingale were immediately attracted to each other and they became life-long close friends. Herbert was instrumental in facilitating her pioneering work in Crimea and in the field of nursing, and she became a key advisor to him in his political career. In 1851 she rejected Milnes' marriage proposal, against her mother's wishes.

Nightingale's career in nursing began in earnest in 1851 when she received four months' training in Germany as a deaconess of Kaiserswerth. She undertook the training over strenuous family objections concerning the risks and social implications of such activity, and the Catholic foundations of the hospital. While at Kaiserswerth, she reported having her most important intense and compelling experience of her divine calling.

On August 12, 1853, Nightingale took a post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854. Her father had given her an annual income of £500 (roughly $50,000 in present terms) that allowed her to live comfortably and to pursue her career.

Crimean War

Statue of Florence Nightingale in Waterloo Place London

Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. On October 21, 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt Mai Smith, were sent (under the authorization of Sidney Herbert) to Turkey, some 545 km across the Black Sea from Balaklava in the Crimea, where the main British camp was based.

Nightingale arrived early in November 1854 in Scutari (modern-day Üsküdar in Istanbul). She and her nurses found wounded soldiers being badly cared for 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.

Nightingale and her compatriots began by thoroughly cleaning the hospital and equipment and reorganizing patient care. However, during her time at Scutari, the death rate did not drop, on the contrary, it began to rise. The death count would be highest of all other hospitals in the region. During her first winter at Scutari, 4077 soldiers died there, which is ten times more from illnesses such as typhus, typhoid, cholera and dysentry, than from battle wounds. Conditions at the hospital were so fatal to the patients because of overcrowding and the hospital's defective sewers and lack of ventilation. A sanitary commission had to be sent out by the British government to Scutari in March 1855, almost six months after Florence Nightingale had arrived, which flushed out the sewers and improved ventilation. Death rates were severely reduced.

Nightingale continued believing the death rates were due to poor nutrition and supplies and overworking of the soldiers. It was not until after she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army, that she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience would influence her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced deaths in the Army during peacetime and turned attention to the sanitary design of hospitals.

Return home

Florence Nightingale returned to Britain a heroine on August 7, 1857, and, according to the BBC, was arguably the most famous Victorian after Queen Victoria herself. Nightingale moved from her family home in Middle Claydon, Buckinghamshire to the Burlington Hotel in Piccadilly. However, she was stricken by a fever of possible psychosomatic origin, in part a delayed response to the stress of her work in the Crimean War and her bout with Crimean fever. She barred her mother and sister from her room and rarely left it. It has been suggested that she may have suffered from bipolar disorder.

In response to an invitation from Queen Victoria – and despite the limitations of confinement to her room – Nightingale played the central role in the establishment of the Royal Commission on the Health of the Army, of which Sidney Herbert became chairman. As a woman, Nightingale could not be appointed to the Royal Commission, but she wrote the Commission's 1,000-plus page report that included detailed statistical reports, and she was instrumental in the implementation of its recommendations. The report of the Royal Commission led to a major overhaul of army military care, and to the establishment of an Army Medical School and of a comprehensive system of army medical records.

It has also been suggested that Nightingale may have used her relationship with Queen Victoria to repress suggestions that Mary Seacole, another nurse working to treat the injured, should be honoured for her work. Seacole was, unlike Nightingale, actually based in the Crimea at Spring Hill, near Kadikoi, between Balaclava and Sevastopol. For further reading on the topic of Nightingale and Seacole see History Today, Volume: 55 Vol: 2 History Today.

Later career

While she was still in Turkey, on November 29 1855, a public meeting to give recognition to Florence Nightingale for her work in the war led to the establishment of the Nightingale Fund for the training of nurses. There was an outpouring of generous donations. Sidney Herbert served as the honorary secretary of the fund, and the Duke of Cambridge was chairman.

By 1859 Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on July 9 1860. (It is now called the Florence Nightingale School of Nursing and Midwifery and is part of King's College London.) The first trained Nightingale nurses began work on May 16 at the Liverpool Workhouse Infirmary. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury, near her family home.

Nightingale wrote Notes on Nursing, which was published in 1860, a slim 136 page book that served as the cornerstone of the curriculum at the Nightingale School and other nursing schools established. Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale would spend the rest of her life promoting the establishment and development of the nursing profession and organizing it into its modern form.

During her bedridden years, she also made pioneering work in the field of hospital planning, and her work propagated quickly across England and the world.

Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Although her ideas met official resistance, they inspired the volunteer body of United States Sanitary Commission.

In 1869 Nightingale with Elizabeth Blackwell, opened the Women's Medical College.

By 1882 Nightingale nurses had a growing and influential presence in the embryonic nursing profession. Some 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, e.g. Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary; Liverpool Royal Infirmary as well as at Sydney Hospital, in New South Wales, Australia.

In 1883 Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1907 she became the first woman to be awarded the Order of Merit. In 1908 she was given the Honorary Freedom of the City of London.

Beginning in 1896 Florence Nightingale was not able to leave her bed. She died on August 13, 1910. The offer of burial in Westminster Abbey was declined by her relatives, and she is buried in the graveyard at St. Margaret Church in East Wellow, England.

Contributions to statistics

Florence Nightingale had exhibited a gift for mathematics from an early age and excelled in the subject under the tutorship of her father. She had a special interest in statistics, a field in which her father was an expert, and was a pioneer in the nascent field of epidemiology. She made extensive use of statistical analysis in the compilation, analysis and presentation of statistics on medical care and public health.

During the Crimean War, Nightingale invented a diagram she called the coxcomb or polar area chart—equivalent to a modern circular histogram or rose diagram —to illustrate seasonal sources of patient mortality in the military field hospital she managed. These were essentially the first contributions to circular statistics. She made extensive use of the coxcomb to present reports on the nature and magnitude of the conditions of medical care in the Crimean War to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports. As such, she was a pioneer in the visual presentation of information, also called Information graphics, and has earned high respect in the field of information ecology. In her later life Nightingale made a comprehensive statistical study of sanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health service in India. In 1858 Nightingale was elected the first female member of the Royal Statistical Society and she later became an honorary member of the American Statistical Association.

Legacy and memory

A young Florence Nightingale

Florence Nightingale's lasting contribution has been her role in founding the nursing profession. She set a shining example for nurses everywhere of compassion, commitment to patient care, and diligent and thoughtful hospital administration.

The work of the Nightingale School of Nursing continues today. There is a Florence Nightingale Museum in London and another museum devoted to her at her family home, Claydon House. The International Nurses Day is celebrated on her birthday each year.

Several churches in the Anglican Communion commemorate Nightingale with a feast day on their liturgical calendars.

There are three hospitals in Istanbul named after Nightingale: F. N. Hastanesi in Şişli, (the biggest private hospital in Turkey), Metropolitan F.N. Hastanesi in Gayrettepe and Avrupa F.N. Hastanesi in Mecidiyeköy, all belonging to the Turkish Cardiology Foundation.

During the Vietnam War, Nightingale inspired many US Army nurses, sparking a renewal of interest in her life and work. Her admirers include Country Joe of Country Joe and the Fish, who has assembled an extensive web site in her honor.

The Agostino Gemelli Medical Centre in Rome, the first university-based hospital in Italy and one of its most respected medical centers, honored Nightingale's contribution to the nursing profession by giving the name "Bedside Florence" to a wireless computer system it has developed to assist nursing.

Trivia

When she first arrived in Turkey, Nightingale would travel on horseback to make inspections. She then transferred to a mule cart and was reported to have escaped serious injury when the cart was toppled in an accident. Following this episode, she used a solid Russian-built carriage, with a waterproof hood and curtains. The carriage was returned to England after the war and subsequently given to the Nightingale training school for nurses, which she founded at St Thomas's Hospital. The carriage was damaged when the hospital was bombed in the Blitz. It was later restored and transferred to the Army Museum in Aldershot.

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Nightingale has long been believed to have been lesbian. She was known to have been in love with a cousin, Marianne Nicholson, and was once proposed to by Nicholson's brother, which she declined. Nightingale later wrote "I have never loved but one person with passion in my life, and that was her". She also wrote "I have lived and slept in the same bed with English Countesses and Prussian farm women... no woman has excited passions among women more than I have." [1]

External links

• 1911 Encyclopedia Britannica article
• John J. O'Connor and Edmund F. Robertson. Florence Nightingale at the MacTutor archive
• Florence Nightingale at American Statistical Association: Statisticians in History
• Works by Florence_Nightingale. Project Gutenberg
• Florence Nightingale Museum
• Material from the Times — As she was quite famous, her death was covered very well in the newspapers.

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