Florence Nightingale, OM (May 12, 1820 – August 13, 1910),
who came to be known as The Lady with the Lamp, was the pioneer of
nursing. Each year, the International Nurses Day is celebrated on her
Often identified with "Florence Nightingale Syndrome" wherein
a nurse falls in love with her patient. While there is no evidence of
Nightingale ever falling in love with a patient, it is referred to as
such because of her great love and caring for all of her patients.
Born into a wealthy and well-connected British family at the 'Villa Colombaia'
in Florence, Italy, she was named after the city of her birth, as was
her older sister (named Parthenope for the old city that is now Naples).
A brilliant and strong-willed woman, Florence rebelled against the
expected role for a woman of her status, which was to become an obedient
Inspired by what she understood to be a divine calling (first experienced
in 1837 at the age of 17 at Embley Park and later throughout her life),
Nightingale made a commitment to nursing, a career with a poor reputation
and filled mostly by poorer women. Traditionally, the role of nurse was
handled by female "hangers-on" who followed the armies; they
were equally likely to function as cooks or prostitutes. Nightingale
was particularly concerned with the appalling conditions of medical care
for the legions of the poor and indigent. She announced her decision
to her family in 1845, evoking intense anger and distress from her family,
particularly her mother.
In December 1844, in response to a pauper's death in a workhouse infirmary
in London that became a public scandal, Nightingale became the leading
advocate for improved medical care in the infirmaries and immediately
engaged the support of Charles Villiers, then president of the Poor Law
Board. This led to her active role in the reform of the Poor Laws, extending
far beyond the provision of medical care.
In 1846 she visited Kaiserwerth, a pioneering hospital established and
managed by an order of Catholic sisters in Germany, and was greatly impressed
by the quality of medical care and by the commitment and practises of
Rejection of marriage proposal
In 1851 she rejected the marriage proposal of politician and poet Richard
Monckton Milnes, 1st Baron Houghton, against her mother's wishes. Convinced
that marriage would interfere with her ability to follow her calling
to nursing, Nightingale continued to reject his proposal.
When in Rome in 1847, recovering from a mental breakdown precipitated
by a continuing crisis of her relationship with Milnes, Nightingale met
Sidney Herbert, a brilliant politician who had been Secretary at War
(1845 – 46), a position he would hold again (1852 – 1854)
during the Crimean War. Herbert was already married but he and Nightingale
were immediately attracted to each other and they became life-long close
friends. Herbert was instrumental in facilitating Nightingale's pioneering
work in Crimea and in the field of nursing, and Nightingale became a
key advisor to Herbert in his political career.
Her career begins
Florence Nightingale's career in nursing began in earnest in 1851 when
she received four months' training in Germany as a deaconess of Kaiserswerth.
She undertook the training over strenuous family objections concerning
the risks and social implications of such activity, and the Catholic
foundations of the hospital. While at Kaiserswerth, Florence reported
having her most important intense and compelling experience of her divine
On August 12, 1853, Nightingale took a post of superintendent
at the Institute for the Care of Sick Gentlewomen in Upper Harley
London, a position she held until October 1854. Her father had given
her an annual income of £500 (roughly $50,000 in present terms)
that allowed her to live comfortably and to pursue her career.
Her most famous contribution was during the Crimean War, which became
her central focus when reports began to filter back to Britain about
the horrific conditions for the wounded. On October 21, 1854, Nightingale
and a staff of 38 women volunteer nurses, trained by Nightingale and
including her aunt Mai Smith, were sent to the Crimea, with the authorisation
of Sidney Herbert.
The hospital in Scutari
She arrived early in November 1854. In Scutari (modern-day Üsküdar
in Istanbul, Turkey) Nightingale 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.
Nightingale and her compatriots began by thoroughly cleaning the hospital
and equipment, and reorganizing patient care. Although she met resistance
from the doctors and officers, her changes vastly improved conditions
for the wounded and by April dropped mortality rates by 40 per cent to
just two per cent. She sent many letters to Herbert, to facilitate better
medical care. She also invented the "polar-area diagram" to
dramatize the extent of the needless deaths in British hospitals during
the Crimean war.
When she first arrived in the Crimea, she travelled on horseback making
the inspections, she then transferred to a mule cart, and was reported
to have escaped serious injury when it was toppled in an accident. Following
this episode she used a solid Russian-built carriage, with waterproof
hood and curtains. The carriage was returned to England after the war
and subsequently given to the Nightingale training school for nurses,
which she founded at St Thomas's hospital. The carriage was damaged when
the hospital was bombed in the Blitz. It was restored and transferred
to the Army Museum in Aldershot.
Reportedly she treated 2,000 patients herself. She also contracted Crimean
Fever. She is remembered today because of the compassion, care and administrative
skills that she introduced to the profession of nursing, to patient care
and to the maintenance of medical records.
Nightingale's work inspired massive public support throughout England,
where she was celebrated and admired as "The Lady with the Lamp" after
the Grecian lamp she always carried in her tireless evening and night-time
visits to injured soldiers. Nightingale's lamp also allowed her to work
late every night, maintaining meticulous medical records for the hospital,
and writing personal letters to the family of every soldier who died
in the hospital. The depth of her commitment to the care of her patients
in Crimea earned her the everlasting respect and affection of the common
Heroic return home
Nightingale returned to Britain a heroine on August 7, 1857, and, according
to the BBC, was arguably the most famous Victorian after Queen Victoria
Florence moved from her family home in Middle Claydon,
Buckinghamshire to the Burlington Hotel in Piccadilly. However, she was
stricken by a
fever of possible psychosomatic origin, in part a delayed response to
the stress of her work in the Crimean War and her bout with Crimean fever.
She barred her mother and sister from her room and rarely left it. It
has been suggested that she may have suffered from bipolar disorder or
myalgic encephalitis. See CBC story: 'Florence Nightingale suffered
from bipolar disorder'
In response to an invitation from Queen Victoria, and despite the limitations
of confinement to her room, Florence Nightingale played the central role
in the establishment of the Royal Commission on the Health of the Army,
of which Sidney Herbert became chairman. As a woman, Nightingale could
not be appointed to the Royal Commission, but she wrote the Commission's
1,000-plus page detailed report that included detailed statistical reports
and was instrumental in the implementation of its recommendations.
Army Medical School
The report of the Royal Commission led to a major overhaul of army military
care, and to the establishment of an Army Medical School and of a comprehensive
system of army medical records.
On November 29, 1855, a public meeting to give recognition to Florence
for her work in the Crimea led to the establishment of the Nightingale
Fund, to raise funds for training of nurses and there was an outpouring
of generous donations. Sidney Herbert served as the honorary secretary
of the fund, and the Duke of Cambridge was chairman.
By 1859, Florence 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 Kings College London.) The first
trained Nightingale nurses began work on May 16 at the Liverpool Workhouse
Infirmary. She also campaigned and raised funds for the Royal Buckinghamshire
Hospital in Aylesbury, near her family home.
Florence Nightingale wrote Notes on Nursing which was published in 1860,
a slim 136-page book that served as the cornerstone of the curriculum
at the Nightingale School and other nursing schools established. Notes
on Nursing also sold well to the general reading public and is considered
as a classic introduction to nursing.
Nightingale spent the rest of her life promoting the establishment and
development of the nursing profession and organizing it into its modern
Nightingale Fund nurses
By 1882 Nightingale nurses had a growing influential presence in the
embryonic nursing profession, and some had become matrons at several
leading hospitals, including, in London, St Mary's Hospital, Westminster
Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables
at Putney; and throughout Britain, e.g. Royal Victoria Hospital, Netley;
Edinburgh Royal Infirmary; Cumberland Infirmary; Liverpool Royal Infirmary
as well as at Sydney Hospital, in New South Wales, Australia.
After the outbreak of the American Civil War in 1861, Nightingale's
work served as an inspiration for nurses in the war, and Union government
approached her for advice to organise field medicine. Although her ideas
met official resistance they inspired the volunteer body of United States
Sanitary Commission  and US volunteers like Dorothea Dix, Clara Barton
and Cornelia Hancock.
In 1869 she returned to England and, with Elizabeth Blackwell, opened
the Women's Medical College.
Mathematician & statistician
Nightingale had exhibited a gift for mathematics from an early age, and
excelled in the subject under the tutorship of her father. She had a
special interest in statistics, a field in which her father was an expert,
and was a pioneer in the nascent field of epidemiology. Florence made
extensive use of statistical analysis in the compilation, analysis and
presentation of statistics on medical care and public health.
In her later life, she made a comprehensive statistical study of sanitation
in Indian rural life and was the leading figure in the introduction of
improved medical care and public health service in India. See Florence
Nightingale, the passionate statistician and Biography of Nightingale
at MacTutor History of Mathematics.
She invented a diagram she called the coxcomb or polar area chart—similar
to today's pie chart—to depict changing patient outcomes in the
military field hospital she managed. She made extensive use of the coxcomb
to present reports on the nature and magnitude of the conditions of medical
care in the Crimean War to Members of Parliament and civil servants who
would have been unlikely to read or understand traditional statistical
reports. As such, she was a pioneer in the visual presentation of information,
now pioneered by Edward Tufte, and has earned high respect in the field
of information ecology. See Polar area chart, or coxcomb, diagram.
In 1858, Florence Nightingale was elected the first female member of
the Royal Statistical Society and she later became an honorary member
of the American Statistical Association.
In 1883 Queen Victoria awarded Florence Nightingale with the Royal Red
Cross and in 1907 she became the first woman to be awarded the Order
of Merit. In 1908 she was given the Honorary Freedom of the City of
London. She could not leave her bed after 1896 and died on August 13,
1910. 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, England.
Florence Nightingale's lasting contribution has been her role in founding
the nursing profession, and in the shining example she set for nurses
throughout the profession of commitment to patient care and hospital
administration. There is a Florence Nightingale Museum in London.
There are countless examples of Florence Nightingale's continuing legacy
in the nursing profession that she founded, from the continuing work
of the Nightingale School of Nursing and throughout the entire field
of nursing education and medical records.
Today, there are three hospitals in Istanbul named after her: F. N.
Hastanesi in Sisli, (the biggest private hospital in Turkey), Metropolitan
F.N. Hastanesi in Gayrettepe and Avrupa F.N. Hastanesi in Mecidiyeköy,
all belonging to the Turkish Cardiology Foundation.
During the Vietnam War, Florence Nightingale served
as an inspiration for many US Army nurses and sparked a continuing renewal
in her life and work, that, inter alia, caught the attention of Country
Joe of Country Joe and the Fish who has assembled an extensive web site
in her honor.
The Agostino Gemelli Medical Centre in Rome, the
first University-based hospital in Italy and one of its most respected
medical centers, is the
research and teaching hospital of Università Cattolica del Sacro
Cuore (Catholic University of the Sacred Heart). It honored Florence
Nightingale's contribution to the nursing profession by giving the name
Bedside Florence to a wireless ward system they have developed that equips
nurses with Compaq iPAQ hand-held computers connected to a Windows 2000