A legend in nursing

Among her many achievements, Florence Nightingale, who died 100 years ago this week, played a central role in establishing nursing as a profession, writes BRIAN MAYE

FLORENCE NIGHTINGALE, who died 100 years ago this week, is popularly remembered as “the Lady with the Lamp” (from her habit of making rounds at night), who did heroic work nursing wounded soldiers during the Crimean War. But more significantly in terms of medical history, she played a central role in establishing nursing as a profession by founding the first secular nursing school in the world in London in 1860.

From a wealthy Victorian background, when at the age of 25 she told her family that she wanted to become a nurse, they were strongly opposed because nursing at the time was associated with working-class women, and the roles a woman of her class was expected to fulfil were those of wife and mother.

It was mainly her mother and sister who disapproved of her wish. Her father, who was an anti-slavery campaigner, had raised her as the son he had never had, and had taught her Greek, Latin, French, German, Italian, history, philosophy and mathematics. Eventually, in 1851, some six years after her first mooting the subject, he agreed to her becoming a nurse.

She felt called by God to the vocation and visited the Lutheran religious community at Kaiserswerth-am-Rhein where she was deeply impressed by the deaconesses’ work with the sick and deprived. She studied to become a nurse at the Institute of Protestant Deaconesses at Kaiserswerth.

In 1853, she was appointed resident lady superintendent of a hospital for invalid women in Harley Street, London. The following year the Crimean War broke out, involving on one side Russia (which had invaded Turkey), and Britain and France on the other. British soldiers, who were sent to Turkey, soon began to be affected by cholera and malaria.

When The Timesnewspaper publicised news of large numbers of them dying from cholera, there was a public outcry and the government was forced to take action. Nightingale, who was friendly with the Secretary for War, Sidney Herbert, was sent with 38 women volunteer nurses, trained by her, to the military hospital at Scutari in Turkey.

The conditions they found there were appalling: the men, still in their dirty uniforms, were unwashed, had no blankets and were poorly fed, and medicines were in short supply.

Given such conditions in military hospitals, it was not surprising that far more (the number may be six times as many) died from cholera, typhus and dysentery than from war wounds. However, the military authorities gave Nightingale little help and she had to enlist the aid of contacts in The Times to publicise how badly the British army treated its own wounded.

There is some dispute about whether it was she who was responsible for improving hygiene conditions and she never claimed credit for helping to reduce the death rate but, what is beyond dispute is that, when she returned to England and collected evidence for the Royal Commission on the Health of the Army, she became convinced of the importance of sanitary living conditions and this influenced the rest of her career.

The publicity generated by her work during the war led to the establishment of the Nightingale Fund for the training of nurses, which she used to set up the Nightingale Training School in St Thomas’s Hospital in London in July 1860. Her Notes on Nursing (1859) became the basis of the school’s curriculum and she devoted the rest of her life to the development of the nursing profession.

One of her great achievements, as a recent biographer Mark Bostridge pointed out, was the introduction of trained nurses into the workhouse system in Britain and Ireland from the 1860s, where the custom had been for sick inmates to be cared for by able-bodied inmates.

Nightingale nurses were soon to become a growing and influential presence in the embryonic nursing profession, not only in Britain but in the United States, Canada and Australia.

From an early age, she had displayed a flair for mathematics and this led to her becoming a capable statistician, a skill she used to present research findings on medical care and public-health issues. She was also adept at presenting her statistical findings visually in diagram form.

Florence Nightingale’s achievements are all the more impressive when they are considered against the background of social restraints on women in Victorian England. In Suggestions for Thought to Searchers after Religious Truth, which she had printed privately in 1860, she opposed the perception of women as almost helpless and rejected a life of thoughtless comfort for one of social service. This written work has been seen by some commentators as an important contribution to English feminism.

However, the greatest achievement of this remarkable woman is the solid foundation she laid on which the modern profession of nursing could be built.