Florence Nightingale

Chelsea

Between Sunday school and the church service at First United Methodist in Little Rock, I would go to our church library. It was there that I discovered Florence Nightingale and embarked on a now-lifelong fascination with the woman who helped invent modern nursing, dramatically improved hospitals, and pioneered data visualization.

Florence was named for her birthplace in Italy in 1820. (Though her parents were British, she was born during their extended honeymoon.) Her parents, especially her father, were committed to her education. She studied math, history, philosophy, and literature, and from a young age, she could read and write in French, German, Italian, Greek, and Latin. At the time, it was seen as imperative for a young woman of her social standing to learn “domestic pursuits,” such as cleaning, cooking, and sewing—and she did. But Florence’s interests lay elsewhere; she was much more interested in having spirited political debates with her father. (A woman after my own heart!)

From the time she was a teenager, Florence believed she had been called to help alleviate human suffering. She dreamed of being a nurse and persevered despite her family’s initial—and staunch—opposition. She defied her parents and signed up for training, becoming first a nurse, and then a superintendent of the Institution for the Care of Sick Gentlewomen in Distressed Circumstances, a hospital in London. She confronted outbreaks of cholera and other diseases while honing her administrative skills and working to improve hygiene throughout the hospital. She had just come to the realization that her passion was training others to become nurses when war broke out on the Crimean Peninsula in 1853.

British newspaper reports from the time depicted horrifying conditions for British soldiers being cared for at hospitals away from the front lines: Supplies were inadequate, conditions were unsanitary, staff was untrained, and patients were crowded into too-small facilities. At the British government’s request, Florence brought a delegation of thirty-eight nurses to try to improve conditions at a hospital in Scutari, the British base hospital in what was then Constantinople.

Florence and her fellow nurses were not welcomed by the military hospital staff, who resented the idea that they should have to answer to a group of civilian women. The hostility of the doctors and the conditions of the hospital led Florence to refer to the facility as the “Kingdom of Hell.” Others might have given up, but Florence was determined to do anything and everything she could to help the soldiers in the hospital whose health was getting worse, not better.

Through tenacity and sheer force of will, Florence and her colleagues implemented basic standards of care at the hospital. Under her leadership, practices like applying clean dressings to wounds, bathing patients, and providing healthy meals became commonplace. She believed that psychological well-being was an important component of recovery—an uncommon view in the 1850s—and spent time helping soldiers write letters home and reading the responses from their loved ones. Her habit of walking the wards at night, tending to patients by a small light she carried with her, led to her being nicknamed “the Lady with the Lamp.”

When the war ended, Florence, suffering from exhaustion and illness, was welcomed home to England as a hero. But she was more interested in continuing her work than being celebrated. She used the money the British government gave her in recognition of her efforts during the Crimean War to establish a hospital and nurse training school in London. She met with government authorities and lobbied for a special commission to further investigate how to improve hospital conditions for soldiers and civilian patients alike. She had kept meticulous records during her time in Turkey. Her careful plotting and colorful visualizations of data, along with her statistical analyses, helped make the case for the importance of hygiene in all medical care. Florence also developed the “coxcomb,” a new type of graph to show how causes of mortality fluctuate over a twelve-month period; it is still in use today. Teaching about Florence Nightingale makes for some of my favorite moments every year at Columbia’s Mailman School of Public Health. My students are often surprised by how much of what we take for granted today can be linked to Florence.

“How very little can be done under the spirit of fear.”

—FLORENCE NIGHTINGALE

Throughout her life, even after she herself was bedridden and homebound with chronic illness, Florence kept up her work to make handwashing, good ventilation, good food, and clean sheets and bandages in hospitals all part of the standard of care—an effort that reduced the mortality rate at the British base hospital in Scutari from 40 percent to 2 percent. She elevated the profession of nursing, and women from across Britain and across different social classes came to her school, hoping to follow her example. Her most popular book, Notes on Nursing: What It Is, and What It Is Not, is still in publication today. Clara Barton, who lived in the same era and founded the American Red Cross, cited Florence as one of her inspirations. When Florence died in 1910, her family respected her wishes and refused a national funeral. “Her life was devoted to the relief of suffering at first,” reported the Times, “while her strength remained, by the tenderness of her own ministrations, and then by the great system of trained nursing which was one of the glories of this age.”