Florence Nightingale - Lady with the lamp

Gerard M Fealy remembers Florence Nightingale: writer, scientist, reformer, and the key individual in founding modern nursing

This year, 2010, is the centennial year of the death of Florence Nightingale (1820 – 1910) and is being celebrated by nurses and nursing organisations all over the world. To mark the occasion, the office of the nursing services director, the HS E and the chief nurse in the Department of Health, together with all the relevant stakeholders including the INMO, are hosting a conference in Dublin Castle on September 7, 2010.

Call from God
Florence Nightingale died at her residence off Park Lane in London in 1910 at the age of 90 as ‘one of the heroines of British history’. Born in Florence, Italy, on May 12, 1820 as the daughter of a wealthy family, Florence was expected to live the life of a cultured ‘lady’ and to marry a gentleman suitor. When she told her family in 1845 that she wished to train as a nurse, they reacted with horror that a lady would wish to do lowly hospital work. Florence persisted in answering her ‘call from God’ and she later declined two offers of marriage.

Intent on her mission, she read widely on the subject of public health and hospitals and in 1849 visited the Institution of Kaiserwerth in Germany, a religious foundation for the relief of poverty founded by the Lutheran clergyman Pastor Theodor Fleidner. She spent a brief period observing the nursing work of the deaconesses, and later she spent three months there training as a probationer. In 1853 she took up her first situation as superintendent of An establishment for gentlewomen during Illness at Upper Harley Street in London.

Crimean War
In 1854 Britain found itself at war with Russia on the Crimean peninsula. The war was pursued with little planning on the part of the British, and even before they fought, the British and Irish troops were weakened and dispirited from cholera and dysentery. Unlike their French allies, the British lacked infrastructure to treat the war casualties, and as a result, many men died or suffered needlessly.

The terrible conditions of the troops were reported by The Times war correspondent William Howard Russell, an Irishman, who bemoaned the inadequate treatment of the wounded. Reporting on the well-organised services of the French Catholic military nurses, Russell asked rhetorically: “Why have we no sisters of charity?”

Russell’s reports caused a public outcry and the secretary for war, Sidney Herbert, turned to Nightingale for assistance. Nightingale responded and in October departed for Turkey with a party of 38 women, including Roman Catholic and Anglican sisters, and on arrival at the military barracks at Scutari in Constantinople on November 3 found a situation of utter chaos. The military hospitals were filthy, overcrowded and rat infested. Nightingale quickly put order on the chaotic situation, ordering supplies of mattresses, bandages and food for the wounded, and she soon gained the confidence of the military doctors and wounded soldiers. She worked tirelessly for months, creating the circumstances in which the wounded could be treated more effectively, efficiently and humanely. In the spring of 1855, she travelled to the Crimean Peninsula to inspect the Balaklava military hospital and while there contracted Crimean Fever. Nightingale was forced to return to Scutari, where she spent the remainder of the war.

The Times reported on Nightingale’s achievements: “She is a ‘ministering angel’ ... [and when] 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.” From such reports, the legend of the Lady with the Lamp was born. Although celebrated as the hero of the Crimea, Nightingale herself did not make a triumphant return, but instead arrived quietly back to her home in Hampshire.

After the war, she became ill and reclusive, and spent much of the remainder of her life at her London home and mostly in bed, the likely victim of brucellosis. Despite prolonged infirmity, she wrote extensively and remained influential in the world beyond her own sickroom for forty years after her Crimean success.

Nightingale School
With funds raised to honour Nightingale’s contribution to the war, a nurse training school was established at St. Thomas’s Hospital in London in 1860. At that time, many medical men believed that sick nursing required only the simplest of instruction. However, advances in scientific medicine led to a demand for educated and skilled nurses and most of the major voluntary hospitals in England and Ireland instituted probationership training in the two decades after the Nightingale School opened.

Nursing reform in this period was accompanied by reforms in the management of hospitals and improvements in the physical conditions for both patients and staff. Nightingale introduced the new training system into a number of Poor Law infirmaries in England and into district nursing services. New nurse training schemes modelled on the Nightingale system soon spread to other countries, including North America, Canada and Australia, and with them went Nightingale’s name and legend.

Scientist and scholar
Nightingale was a prolific writer. Her most famous work Notes on Nursing (1860) was printed in several languages and she also wrote Notes on Hospitals (1863) and Introductory Notes on Lying-in Institutions (1871). She wrote a treatise on the prevention of venereal disease among prostitutes (1863) and wrote on women’s issues, including gender roles and marriage (McDonald 2005).

Nightingale studied statistics and used her famous polar-area diagram to demonstrate how preventable diseases like dysentery and cholera were the principal cause of death in the Crimea. She wrote extensively on hospital hygiene, ‘the health of houses’ and on the design of hospitals, advocating the pavilion style, which provided for good light, good ventilation and good spacing of beds. She also studied the statistics of fevers and other hospital infections.

Ireland
Nightingale visited Ireland on at least two occasions and had close working relations with Irish military nurses in the Crimean campaign. She admired Roman Catholic sisterhoods and the training that they received as nurses. In 1852 she planned a visit to St Vincent’s Hospital in Dublin, but on arriving found that it was closed for repairs and she later wrote that ‘my mission to Ireland has entirely failed’. It is not certain what precisely her mission was, although there is evidence that she intended to study nursing there for three months.

Nightingale worked closely with the Irish Sisters of Mercy in the Crimea, including Mary Clare Moore of the Bermondsy Convent and the Irish Sisters of Mercy who travelled from Kinsale under Mother Frances Bridgeman. Nightingale’s relationship with the party from Ireland was initially fraught and on arriving at Constantinople, the sisters were told by Nightingale that they were ‘not wanted’. Nightingale’s acrimony towards the Kinsale nuns was partly related to her not having direct authority over them, but also to the undercurrent of racial and sectarian tensions prevalent at that time. Nightingale eventually came to respect the work of the Sisters of Mercy and she discussed the Irish system of nursing with Bridgeman at Balaklava. As Bridgeman spoke, “Miss N took notes on our manner of nursing”, although it is not certain that any of what Nightingale wrote was included in Notes on Nursing, which she later published.

Legacy
Florence Nightingale was a wealthy English Victorian lady who made an impact on the society of her time and a century after her death her legacy is her writing as well as the sanitary reforms of public institutions.

She was a writer, scientist, political lobbyist and social reformer, who used her writings for political and not just scientific ends. Her connections with many influential people accounted for much of her success as a social reformer. Since her death in 1910, she has been the subject of both adulation and fascination among historians, nurses and the general public. For most nurses, Florence Nightingale will remain a very special figure and the key individual in the founding of modern nursing.

Gerard M Fealy is the associate professor/director of graduate research and director of the Irish Centre for Nursing & Midwifery History, at the UCD School of Nursing, Dublin

Florence Nightingale - Lady with the lamp

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