See biographies by C. Woodham-Smith (1950, 1983), E. Huxley (1975), B. M. Dossey (2000, repr. 2009), H. Small (2000), G. Gill (2004), and M. Bostridge (2008); M. Vicinus and B. Nergaard, ed., Ever Yours, Florence Nightingale: Selected Letters (1989); studies by F. B. Smith (1982), M. E. Baly (1986, repr. 1998), and S. Dengler (1988).
(born May 12, 1820, Florence, Italy—died Aug. 13, 1910, London, Eng.) Italian-born British nurse, founder of trained nursing as a profession. As a volunteer nurse, she was put in charge of nursing the military in Turkey during the Crimean War. Her first concern was sanitation: patients' quarters were infested with rats and fleas, and the water allowance was one pint per head per day for all purposes. She used her own finances to purchase supplies. She also spent many hours in the wards; her night rounds giving personal care to the wounded established her image as the “Lady with the Lamp.” Her efforts to improve soldiers' welfare led to the Army Medical School and a Sanitary Department in India. She started the first scientifically based nursing school, was instrumental in setting up training for midwives and nurses in workhouse infirmaries, and helped reform workhouses. She was the first woman awarded the Order of Merit (1907).
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Her parents were William Edward Nightingale (1794–1875) and Frances ('Fanny') Nightingale née Smith (1789–1880). William Nightingale was born William Edward Shore. His mother Mary née Evans was the niece of one Peter Nightingale, under the terms of whose will William Shore not only inherited his estate Lea Hurst in Derbyshire, but also assumed the name and arms of Nightingale. Fanny's father (Florence's maternal grandfather) was the abolitionist William Smith.
Inspired by what she took as a Christian divine calling, experienced first in 1837 at Embley Park and later throughout her life, Florence announced her decision to enter nursing in 1845, despite the intense anger and distress of her family, particularly her mother. In this, she rebelled against the expected role for a woman of her status, which was to become a wife and mother. In those days, nursing had a poor reputation, being performed mostly by poorer women, "hangers-on" who followed the armies. In fact, nurses were equally likely to function as cooks.
She cared for poor and indigent people. In December 1844, in response to a pauper's death in a workhouse infirmary in London that became a public scandal, she 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. She was later instrumental in mentoring and then sending Agnes Elizabeth Jones and other Nightingale Probationers to Liverpool Workhouse Infirmary.
Nightingale was courted by politician and poet Richard Monckton Milnes, 1st Baron Houghton, but she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing. When in Rome in 1847, recovering from a mental breakdown precipitated by a continuing crisis of her relationship with Milnes, she met Sidney Herbert, a brilliant politician who had been Secretary at War (1845–1846), a position he would hold again during the Crimean War. Herbert was already married, but he and Nightingale were immediately attracted to each other and they became lifelong close friends. Herbert was instrumental in facilitating her pioneering work in the Crimea and in the field of nursing, and she became a key advisor to him in his political career. In 1851, she rejected Milnes' marriage proposal, against her mother's wishes.
Nightingale also had strong and intimate relations with Benjamin Jowett, particularly about the time that she was considering leaving money in her will to establish a Chair in Applied Statistics at the University of Oxford.
In 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein 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.
On 22 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 £25,000/US$50,000 in present terms), which allowed her to live comfortably and to pursue her career. James Joseph Sylvester is said to have been her mentor.
Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). 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.
Florence was a proponent of the Miasma theory of disease; therefore, she and her colleagues began by thoroughly cleaning the hospital and equipment and reorganising patient care. However, during her time at Scutari, the death rate did not drop; on the contrary, it began to rise. The death count was the highest of all hospitals in the region. During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. Conditions at the temporary barracks hospital were so fatal to the patients because of overcrowding and the hospital's defective sewers and lack of ventilation. A sanitary commission had to be sent out by the British government to Scutari in March 1855, almost six months after Florence Nightingale had arrived, which flushed out the sewers and improved ventilation. Death rates were sharply reduced.
Nightingale continued believing the death rates were due to poor nutrition and supplies and overworking of the soldiers. It was not until after she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army that she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience would influence her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced deaths in the army during peacetime and turned attention to the sanitary design of hospitals.
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. Her goal to help the British soldiers in the Crimean War earned her world respect as a nurse and leader. This was no easy job because many of the soldiers at Scutari resented her intelligence and did what they could to weaken her work. It is directly through her thorough observations that the association linking sanitary conditions and healing became recognized and established. “Within 6 months of her arrival in Scutari, the mortality rate dropped from 42.7 percent to 2.2 percent“(Neeb 3-4). Florence insisted on adequate lighting, diet, hygiene, and activity. “She understood even then that the mind and body worked together, that cleanliness, the predecessor to our clean and sterile techniques of today, was a major barrier to infection, and that it promoted healing”(Neeb 3-4). She vigilantly observed and documented notes what changes in conditions occurred within each of the soldiers, which led to her admiration as “The Lady with the Lamp”.
Nightingale was a advocate for the improvement of care and conditions in the military and civilian hospitals in Britain. Among her popular books are Notes on Hospitals, which deals with the correlation of sanitary techniques to medical facilities; Notes on Nursing, which was the most valued nursing text textbook of the day; Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army. The first official nurses’ training program, the Nightingale School for Nurses, opened in 1860. The mission of the school was to train nurses to work in hospitals, work with the poor, and to teach. This intended that students cared for people in their homes, an appreciation that is still advancing in reputation and professional opportunity for nurses today.
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 popularised by Henry Wadsworth Longfellow's 1857 poem "Santa Filomena":
Lo! in that hour of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
In response to an invitation from Queen Victoria – and despite the limitations of confinement to her room – 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 report, that included detailed statistical reports, and she was instrumental in the implementation of its recommendations. The report 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.
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 9 July 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 16 May 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 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 a classic introduction to nursing. Nightingale would spend the rest of her life promoting the establishment and development of the nursing profession and organizing it into its modern form.
Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission.
In 1869, Nightingale and Dr Elizabeth Blackwell opened the Women's Medical College.
In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the USA with adequate training and knowledge to establish high-quality nursing schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.
By 1882, Nightingale nurses had a growing and influential presence in the embryonic nursing profession. 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 and Liverpool Royal Infirmary, as well as at Sydney Hospital in New South Wales, Australia.
In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1907, she became the first woman to be awarded the Order of Merit. In 1908, she was given the Honourary Freedom of the City of London.
By 1896, Florence Nightingale was bedridden. She may have had what is now known as chronic fatigue syndrome. Her birthday is now celebrated as the International CFS Awareness Day. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world.
Florence Nightingale had exhibited a gift for mathematics from an early age and excelled in the subject under the tutorship of her father and later the tutorship of mathematician James Joseph Sylvester. She had a special interest in statistics, a field in which her father, a pioneer in the nascent field of epidemiology, was an expert. She made extensive use of statistical analysis in the compilation, analysis and presentation of statistics on medical care and public health.
Nightingale was a pioneer in the visual presentation of information and statistical graphics. Among other things she used the pie chart, which had first been developed by William Playfair in 1801. After the Crimean War, Nightingale used the polar area diagram, equivalent to a modern circular histogram or rose diagram, to illustrate seasonal sources of patient mortality in the military field hospital she managed. Nightingale called a compilation of such diagrams a "coxcomb", but later that term has frequently been used for the individual diagrams. She made extensive use of coxcombs 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.
In her later life Nightingale 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.
Cassandra protests the over-feminization of women into near helplessness, such as Nightingale saw in her mother's and older sister's lethargic lifestyle, despite their education. She rejected their life of thoughtless comfort for the world of social service. The work also reflects her fear of her ideas being ineffective, as were Cassandra's. Cassandra is a virgin-priestess of Apollo who receives a divinely-inspired prophecy, but her prophetic warnings go unheeded. Elaine Showalter called Nightingale's writing "a major text of English feminism, a link between Wollstonecraft and Woolf.
Nightingale was a Christian universalist. On 7 February 1837 – not long before her 17th birthday – something happened that would change her life: "God spoke to me", she wrote, "and called me to His service."
The work of the Nightingale School of Nursing continues today. The Nightingale building in the School of Nursing and Midwifery at the University of Southampton is named after her. International Nurses Day is celebrated on her birthday each year.
The Florence Nightingale Declaration Campaign, established by nursing leaders throughout the world through the Nightingale Initiative for Global Health (NIGH), aims to build a global grassroots movement to achieve two United Nations Resolutions for adoption by the UN General Assembly of 2008 which will declare: The International Year of the Nurse–2010 (the centennial of Nightingale's death); The UN Decade for a Healthy World–2011 to 2020 (the bicentennial of Nightingale's birth). NIGH also works to rekindle awareness about the important issues highlighted by Florence Nightingale, such as preventive medicine and holistic health. So far, The Florence Nightingale Declaration has been signed by over 18,500 signatories from 86 countries.
During the Vietnam War, Nightingale inspired many US Army nurses, sparking a renewal of interest in her life and work. Her admirers include Country Joe of Country Joe and the Fish, who has assembled an extensive website in her honour.
Three hospitals in Istanbul are named after Nightingale: F. N. Hastanesi in Şişli (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.
The Agostino Gemelli Medical Center in Rome, the first university-based hospital in Italy and one of its most respected medical centres, honoured Nightingale's contribution to the nursing profession by giving the name "Bedside Florence" to a wireless computer system it developed to assist nursing.
There are many foundations named after Florence Nightingale. Most are nursing foundations, but there is also Nightingale Research Foundation in Canada, dedicated to the study and treatment of chronic fatigue syndrome, which Nightingale is believed to have had.
There is a psychological effect known as the "Florence Nightingale Effect", whereby nurses and doctors fall in love with their patients.
A bronze plaque, attached to the plinth of the Crimean Memorial in the Haydarpaşa Cemetery, Istanbul and unveiled on Empire Day, 1954 to celebrate the 100th anniversary of her nursing service in that region, bears the inscription:
"To Florence Nightingale, whose work near this Cemetery a century ago relieved much human suffering and laid the foundations for the nursing profession."
There are three statues of Florence Nightingale in Derby - one outside the Derby Royal Infirmary, one in St. Peter's Street, and one above the Nightingale-Macmillan Continuing Care Unit opposite the Derby Royal Infirmary.
There is a Florence Nightingale Museum in London and another museum devoted to her at her sister's family home, Claydon House, now a property of the National Trust. The northernmost tower of the Selimiye Barracks building is today a museum, and in several of its rooms, relics and reproductions relevant to Florence Nightingale and her nurses are on exhibition.
When she first arrived in Turkey, Nightingale would travel on horseback to make inspections. She then transferred to a mule cart and was reported to have escaped serious injury when the cart was toppled in an accident. Following this episode, she used a solid Russian-built carriage, with a 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 by Nazi Germany during the Second World War. It was later restored and transferred to the Army Medical Services Museum in Mytchett, Surrey, near Aldershot.
In 1912 a biographical silent film titled "The Victoria Cross" starring Julia Swayne Gordon as Florence was produced.
In 1915 another biographical silent film titled Florence Nightingale was produced starring Elisabeth Risdon.
In 1936 a biographical film titled "White Angel" was produced concerning Florence Nightingale's nursing activities during the Crimean War, starring Kay Francis as Florence. (Produced by First National Pictures.)
A 1951 a second "talkie" biographical film titled "The Lady With The Lamp" was produced starring Anna Neagle as Florence Nightingale.
In 1985 a TV biopic "Florence Nightingale", starring Jaclyn smith as Florence, was produced.
Beginning in 1968, the U.S. Air Force operated a fleet of 20 C-9A "Nightingale" aeromedical evacuation aircraft, based on the McDonnell Douglas DC-9 platform. The last of these planes was retired from service in 2005.