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Florence Nightingale
Called to the Crimea and Beyond
A woman wearing black boots, a black wool gown, and a white bonnet walked slowly down the dim hallway, appraising the dismal scene. Men lay side by side on the hospital floor, their ragged clothing soiled with excrement, dried mud, and blood. In addition to their battle wounds, they suffered from cholera and dysentery and were crawling from head to toe with vermin. Medicine and basic medical supplies were virtually nonexistent, and even food was scarce. Some of the patients were served raw meat and little else. The conditions were the worst she had ever seen.
Never in the Army’s history had such unrestricted access to a military hospital been granted to a woman. Florence Nightingale and her thirty-eight nurses made history as they stepped across the threshold of this rudimentary hospital on the edge of the Black Sea. But they couldn’t be preoccupied with such distractions. More work waited than they could possibly manage, and every day hundreds more injured and dying British soldiers were taken ashore and transported up the steep slope to a hospital sorely unequipped to treat them.
He Called Her to His Service
From the start, Florence Nightingale was certain her life’s calling was to help suffering people. By the time she was a teenager, Florence was regularly visiting the village’s ill and needy. She recorded prescriptions and remedies in a notebook constructed out of scrap paper and old letters. She also included observations related to the illnesses of family members, noting, for instance, how many teeth “Pop” had pulled at the dentist and the status of Uncle Octavius’s lower back pain. When the influenza epidemic swept through southern England in 1837, Florence was the only member of the household, aside from her grandmother and the cook, who did not fall ill. For a month she tirelessly nursed her family members and others, concluding, when the worst of the flu had subsided, “I have killed no patients, though I have cured few.”1
While Florence took a rational approach to faith, she also consistently sought personal union with God. As a child, Florence once conducted an experiment to determine if her prayers were being answered. She recorded what she prayed for, as well as what she considered an appropriate amount of time for the prayer to be answered, but was disappointed to find that when she looked for the results of divine intervention, she couldn’t find much evidence for it. On the other hand, she often found the presence of God in nature and in the acts of goodwill she witnessed in the people around her. While Florence remained a nominal Anglican, she ceased attending church regularly by the time she was in her thirties. She was influenced by a wide range of philosophies and theologies, including the medieval Roman Catholic mystics, Lutheranism, the teachings of John Wesley, and the social progress and public-service elements of Unitarianism.
Because she was so rational minded and leery of the supernatural, Florence always carefully analyzed each call she heard from God to discern whether it was an inward revelation or a mystical or hallucinatory sensation. Not long after the flu epidemic, on February 7, 1837, a date noted in her personal calendar, Florence heard a call from God. The voice did not specify exactly what form her service would take, but it was clear enough to convince Florence that she should not dismiss it.
Called to the Crimea
Despite her obvious passion for and skills at nursing, Florence’s parents had no intention of allowing their daughter to pursue such a career. It was unthinkable that Florence, a wealthy, upper-class, educated gentlewoman, would consider an occupation so closely connected to domestic service. Upon hearing of their daughter’s plan to train at the Salisbury Infirmary, William and Fanny Nightingale dismissed it as selfish foolishness. Furthermore, they reasoned, Florence was expected to marry, and as an attractive young lady, she had plenty of suitors from whom to choose. One, the politician and poet Richard Monckton Milnes, courted her for nine years before she ultimately rejected him to pursue her calling.
For a while, Florence accepted her parents’ wish and bitterly acquiesced to the life of a gentlewoman. Her dreams crushed, she fell into a deep depression. “God has something for me to do for Him or He would have let me die some time ago,” she wrote. “I hope to do it by living, then my eyes would have indeed seen His salvation, but now I am dust and nothing, worse than nothing, a curse to myself and to others.”2 As it turned out, Florence simply could not abandon what she understood as her God-given calling. “O God, Thou puttest into my heart this great desire to devote myself to the sick and sorrowful,” she wrote in her diary while traveling in Egypt. “I offer it to Thee. Do with it what is for Thy service.”3
After unsuccessfully pleading with her father one more time to change his mind, she began to research hospitals in private and secretly settled on the Institution of Nursing Sisters, which had been founded by the prison reformer Elizabeth Fry at Kaiserswerth, Germany, in 1840. Although her stay at Kaiserswerth was brief, Florence observed the work of each ward in the hospital, as well as the spartan living conditions of the deaconesses. She later summarized her findings in a thirty-two-page pamphlet, “The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses.” When Florence returned to London in 1853, she accepted a job as superintendent at the Institute for the Care of Sick Gentlewomen. Noting that his daughter would not be deterred, William Nightingale offered her an annual income that generously augmented her salary.
In late 1854, Florence received a letter that changed her life. Her good friend Sidney Herbert, Britain’s secretary of war, asked her to organize a corps of nurses to tend to the sick and wounded soldiers in the Crimea. This was a dramatic and desperate step by the British government. Up to this point no female nurses had been stationed at hospitals in the war, not only on account of their gender, but also as a result of their poor reputation. Many nurses lacked real caretaking skills, were inclined to drunkenness, and spent more time cavorting with the patients in the wards after dark than they did actually caring for them. However, as thousands of wounded, ill, and dying soldiers poured into understaffed hospitals, England had no choice but to call in female nurses. Within weeks of receiving Herbert’s letter, Florence accepted the position of superintendent of nurses in the English general military hospitals in Turkey. She assembled a team of thirty-eight nurses from a variety of religious orders and sailed with them to the Crimea, disembarking in Scutari on the morning of November 4, 1854.
Because of their tenuous position, the nurses initially were not allowed to care for any of the soldiers in the ward unless granted explicit permission by the medical officer in charge. Florence adhered to the military regulations with scrupulous attention. Neither she nor any of her nurses even entered a ward or fetched so much as a bedpan unless specifically requested to do so. However, it didn’t take long, with five hundred gravely ill and wounded men arriving at a time, for the surgeons and medical officers to abandon the protocol. Soon Florence and her nurses were working twenty-hour shifts, soaking off the filthy, bloody bandages from wounds that had been dressed on the battlefield ten days earlier, assisting with amputations, and administering what basic care they could with so few supplies. “We are steeped up to our necks in blood,” Florence wrote.4
When she wasn’t involved in triage, Florence tackled the appalling conditions in the hospital, which was rife with rats, lice, and other vermin. She embarked on a vigorous campaign to wash the men, feed them nutritious food, and provide clean clothes and bedding. She obtained boilers from the Army engineers and transformed a small house near the hospital into a laundry. She bypassed official government procedures and convinced Herbert to send supplies directly from London. And after her appeal was published in The Times, she received hundreds of pieces of linen and thousands of pounds in donations. She also planned for, organized, and paid out of her own pocket for two hundred Turkish carpenters to refloor a section of the Barrack Hospital that had been damaged by a fire.
Despite Florence’s herculean efforts, the death toll skyrocketed to 42 percent over the winter of 1855, not from war wounds, but from illnesses like dysentery and cholera. When the British government finally sent the Sanitary Commission to investigate the hospital in March of 1855, it was discovered that the building sat on a cesspool, with its sewers clogged with the carcasses of rotting animals. A decomposing horse blocked a large pipe that carried water into the hospital. Likewise, raw sewage was found to be seeping into the hospital’s water supply. The sanitation team cleared the hospital’s ventilation system, repaired windows so they could be opened, refloored the corridors, whitewashed walls, and reengineered the flow of sewage into the sea. By June of 1855, the mortality rate at the hospital swiftly declined to 2 percent. At the time, credit for the turnaround was given to the sanitation overhaul, although more recently historians have noted that the improvement was more likely due to the arrival of warmer weather and an overall reduction in overcrowding at the hospital.
Florence has been both criticized and canonized for her role in the Crimean War. As biographer Gillian Gill notes, “In the nineteenth century too much credit for that drop [in mortality] was probably given to Florence Nightingale in person. In the twentieth century she was certainly given too little.”5 The fact is, while Florence initially believed the death rates at her hospital were due to poor nutrition, a lack of supplies, and the overworking of soldiers, after she returned to Britain and began to collect evidence for the Royal Commission on the Health of the Army, she came to believe that most of the soldiers died as a result of poor sanitary conditions. This knowledge profoundly influenced her later career, when, though largely bedridden by a chronic illness, she advised the British government on military hospital reform, advocated for sanitation improvements in Britain and India, founded a nurses’ training school at St. Thomas’s Hospital in London, and wrote Notes on Nursing, which was used as a cornerstone of nursing curriculum for decades.
To highlight only the romanticized, mythologized version of Florence Nightingale as the “lady with the lamp” is to do a disservice to some of her most significant and lasting contributions in nursing, military hospital reform, and hospital sanitization. Yes, she toiled at the bedside of thousands of injured and dying men and walked miles of dim corridors with an oil lamp burning brightly in her hands. But her work following the war, conducted largely from the confines of her own bed, was equal to if not more important than her wartime service for its impact on the overall history of health care. When Florence offered her skills and passion, her “great desire to devote [herself] to the sick and sorrowful” to God that day during her vacation in Egypt, she could have never imagined the outcome. God used Florence Nightingale’s great desire and devotion beyond her wildest expectations.6