Out Spotlight

Today's Out Spotlight has been called an Angel of Mercy, and the Lady with the Lamp. She transformed hospitals and pioneered the modern nursing profession. No other person in history has done more to alleviate suffering and establish so high a standard of health care for the sick. Her name is synonymous with care. Today's Out Spotlight is Florence Nightingale.

Nightingale was born into a rich, upper-class, well-connected British family at the Villa Colombaia, near the Porta Romana at Bellosguardo in Florence, Italy, on May 12, 1820 and was named after the city of her birth. Florence's older sister Frances Parthenope had similarly been named after her place of birth, Parthenopolis, a Greek settlement now part of the city of Naples.

Her parents were William Edward Shore and Frances ("Fanny") Smith. William's mother Mary was the niece of one Peter Nightingale, under the terms of whose will William inherited his estate Lea Hurst in Derbyshire, and assumed the name and arms of Nightingale. Florence’s maternal grandfather was the abolitionist and Unitarian William Smith.

Inspired by what she took as a call from God in February 1837 while at Embley Park, at the age of 17, she announced her decision to enter nursing in 1844, despite the outcry of her mother and sister. In doing this, she rebelled against the expected role for a woman of her status, which was to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in spite of opposition from her family and the restrictive societal code for affluent young English women. Courted by the politician and poet Richard Monckton Milnes, 1st Baron Houghton, she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.

Nightingale traveled throughout Europe and as far as Greece and Egypt. Her writings on Egypt in particular are testimony to her learning, literary skill and philosophy of life. 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." Later in 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein in Germany, where she observed Pastor Theodor Fliedner and the deaconesses 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; she also received four months of medical training at the institute which formed the basis for her later care.

In August 1853, Nightingale took the 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 £40,000/US$65,000 in the present day economy), which allowed her to live comfortably and to pursue her career.

She exploded into public consciousness during the Crimean War (1853-1856). Serving as the superintendent at the Institute for the Care of Sick Gentlewomen in London from 1853-1854, she learned of the horrible conditions soldiers faced during Britain's Crimean War with Russia.

Using her friendship with politician Sidney Herbert to gain official approval, Nightingale trained 38 nurses and traveled to Turkey, arriving at a hospital in Scutari (modern day Istanbul) in November of 1854.

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.

After Nightingale sent a plea to The (London) Times for the government to produce a solution to the poor condition of the facilities, the British Government commissioned Isambard Kingdom Brunel to design a prefabricated hospital, which could be built in England and shipped. The result was Renkioi Hospital, a civilian facility which under the management of Dr Edmund Alexander Parkes had a death rate less than 1/10th that of Scutari.The Scutari hospitals had the highest mortality levels in the region. Overcrowding, defective sewage systems and poor ventilation contributed to soldiers' illnesses and death. While a sanitary commission sent by the British government took over six months to arrive, Nightingale and her nursing crew cleaned up the hospital and delivered an unprecedented level of nursing care.

During the Crimean war, she gained the nickname "The Lady with the Lamp", deriving from a phrase in a report in The Times:

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.

The phrase was further popularized by Henry Wadsworth Longfellow's 1857 poem "Santa Filomena":

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

While she was in the Crimea, on November 29 1855, there was a public meeting to give recognition to 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. Friend Sidney Herbert served as honorary secretary of the fund, and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, on the basis of her letters from 1856 in which she wrote of spas in the Ottoman Empire, detailing the health conditions, physical descriptions, dietary information, and other vitally important details of patients whom she directed there (where treatment was significantly less expensive than in Switzerland).
By the time she left her post, Nightingale had earned the military's admiration. She returned to Britain as a hero in 1857.

Confined to bed by fever upon her return, Nightingale refused to let her illness diminish her work. She helped establish the Royal Commission on the Health of the Army and wrote its first report, a document that facilitated an overhaul of army medical care and record-keeping. "Notes on Nursing: What It Is and What It Is Not," her instructional guide published in 1860, continues to influence nursing schools across the globe.

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 1865 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 1859, a slim 136-page book that served as the cornerstone of the curriculum at the Nightingale School and other nursing schools established, though it was written specifically for the education of those nursing at home. She 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 recognized as the knowledge which every one ought to have – distinct from medical knowledge, which only a profession can have.”

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. She spent the rest of her life promoting the establishment and development of the nursing profession and organizing it into its modern form. 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".

One of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in England and Ireland from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. This innovation may be said to herald the establishment of the National Health Service in Britain, forty years after Nightingale's death.

A brilliant mathematician and writer, Nightingale used a unique ability to simplify complex statistics to communicate her findings to government officials. Historians consider her book "Cassandra" (1928) a major feminist work.

She had several important and passionate friendships with women. Later in life she kept up a prolonged correspondence with an Irish nun, Sister Mary Clare Moore, with whom she had worked in Crimea. Her most beloved confidante was Mary Clarke, an Englishwoman she met in 1837 and kept in touch with throughout her life. She also often referred to herself in the masculine, as for example "a man of action" and "a man of business".

In spite of these deep emotional attachments to women, some scholars of Nightingale's life believe that she remained chaste for her entire life; perhaps because she felt an almost religious calling to her career, or because she lived in the time of Victorian sexual morality.

Queen Victoria awarded Nightingale the Royal Red Cross in 1883. In 1907, Nightingale became the first woman to receive the Order of Merit. Hospitals, foundations, and other organizations in her name continue to advocate for improved health care. The Florence Nightingale Museum in London commemorates her life.

On August 13, 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street, Park Lane. 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, Hampshire. She left a large body of work, including several hundred notes which were previously unpublished.

"I think one's feelings waste themselves in words; they ought all to be distilled into actions which bring results."