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Home , Florence Nightingale

FACTS ABOUT NIGHTINGALE BIRTH AND EARLY LIFE • Born in Florence, Italy, on May 12th, 1820 (named for the city) to an affluent British family • Nightingale was active in philanthropy as a child, and believed to be her “divine purpose” (.com, Background and early life section).

NURSING EDUCATION AND BEGINNING CAREER • Enrolled at the nursing program at the Institution of Protestant Deaconesses in Kaiserswerth, Germany in 1850-1851. • Found employment at the Harley Street as a nurse, and was soon promoted to superintendent all in 1853 (Biography.com, Background and early life section). • Her parents viewed her career choice as unwise, given her social position and the expectation that she might “marry a man of means to ensure her class standing.”

DID YOU KNOW? Nightingale was a prodigious and versatile . She was also a pioneer in data with the use of , effectively using graphical presentations of statistical data. (Bostridge, Mark, 17 February 2011)

Painting of Nightingale by of Nightingale , c. 1840s by Kilburn, c. 1854

CRIMEAN WAR • In October 1853, the broke out between the Turks and Russia, which eventually involved England and France in the spring of 1854. As the English and French sent their troops to Turkey as allies, there was a need for a mobile nursing unit to accompany them and handle the outbreaks of , , and other serious disorders – as well as treat those who had succumbed to battle injuries. • Florence Nightingale was asked to lead a volunteer group of nurses to Scutari, which was the Greek name for a district in . She was just 34 years old. • She gathered additional supplies from vendors in Marseilles on her way to Turkey, which proved extremely vital when she finally arrived. • The medical officers on the scene in Scutari saw the female nursing party as “meddling outsiders” and declined their services. In spite of this, she began to keep “detailed daily records of wounds, diseases, and deaths; contaminated food and water; lack of supplies; and major organizational problems with the army’s Medical Department” (Dossey, 2000, pg. 124). • Conditions in the hospital wards were awful: vermin infestations; overflow casualties were laid on both sides of the hallways; blankets made of canvas; and perhaps worst, sewer lines were blocked and toilets overflowed into the hallways (it was also winter, so the windows were closed against the cold). Shipments of supplies were delayed, and it caused so much stress for the medical team that Nightingale insisted a government shipping warehouse be established in Scutari itself. She was able to procure as many as “6,000 shirts, 2,000 socks, 500 pairs of drawers, nightcaps, slippers, knives, forks, wooden spoons, trays, tables, forms, clocks, operating room tables, scrubbers, towels, soap, screens, spoons, tin baths, combs, precipitate for destroying lice, scissors, bedpans, and stump pillows” (Dossey, 2000, pg. 130).

1 LADY WITH THE LAMP • Nightingale worked as many as 20 hours a day during the war. She developed a reputation for her tireless efforts reviving and stabilizing soldiers who were originally deemed terminal. She also requested to take on the most severe cases personally. • At nighttime she made her solitary rounds in the hospital carrying a lantern, earning her the nickname the “Lady with the lamp.” This image of Nightingale became infamous through poetry and song, and her likeness was captured in sculpture, woodcuts, and statues. • Her efforts attracted the attention of by the fall of 1854. In mid-December, Queen Victoria told Nightingale that she would be sending the soldiers and nursing staff warm scarves, as a sign of support and care. • Nightingale also advocated for the barrack hospital where she worked, asking for adequate stores and stressing the importance of careful record-keeping. She also wanted the soldiers to resign themselves to the status of “patient” and allow the nursing staff to care for them, rather than care for themselves as they were trained to do. Improving the soldier’s stay in the hospital by way of providing meals, hospital furniture, and clothing was very important. She also extended this program to the front lines of the battlefield, developing recommendations for a system that would later become known as rationing. She was also responsible for the establishment of a house steward to direct washing, cooking, cleaning, and coordination of the orderlies to keep the hospital running efficiently.

DID YOU KNOW? She kept a pet owl named Athena for 5 years during her time in Turkey. The owl is currently on display at the Florence Nightingale Museum in London, England.

Florence Nightingale, an angel Photograph of Nightingale of mercy. Scutari hospital 1855 by Henry Hering, c. 1860

ENGLISH ARMY’S MEDICAL REFORMS • In 1855, Nightingale received accolades for her work at the barrack hospital in Scutari: The Sultan of Turkey presented her with a diamond and carnelian bracelet, as well as a sum of money for the nurses. Queen Victoria also gave her a badge with the phrase “Blessed are the merciful.” • Nightingale returned to England from the war in 1856. • Upon her return, she made it her new mission to ensure that the oversight, unpreparedness, and problems that had riddled the barrack hospital never returned. She began to “spearhead the major reforms for the English army’s Medical Department.” (Dossey, 2000, pg. 186). • Some of her main army proposals for reform were as follows: -- In all army units, soldiers must be trained to take care of themselves beyond just on the battlefield – a new degree of self-sufficiency must be created. -- An inventory of items in the warehouses must be periodically reported to officers in the field. -- Transport of supplies must be handled by military command, to ensure the items’ safety and effective delivery. -- A sanitary officer must be assigned to advise on proper encampment sites, diets, clothing, etc. -- The management of general must be consolidated under one department. -- Standards of needed to be developed, including furniture and storage closets within hospitals, to ensure a fully- sanitized working and healing space. -- Overall modernization and re-structuring of the army’s Medical Department, including clearly-defined job descriptions, policies and procedures, and creation of an army medical school. -- Cooks should be assigned to hospitals to ensure a healthy diet can be provided to all patients. -- Both male and female nurses should be used in military hospitals -- All hospitals should be engineered to provide the best conditions for lighting, especially direct sunlight, adequate sewerage and drainage, ventilation, heating and cooling, water supply, sufficient space per patient, etc. (Dossey, 2000, pg. 190-192) 2 LATER CAREER AND LEGACY • Since returning to England, she had continually suffered from extreme fatigue, insomnia, lack of appetite, nausea at the sight of food, irritability, nervousness, and intermittent depression. She collapsed from severe palpitations in August 1857. She was sent for “water cure” treatment at a medicinal spring in Malvern. She declared herself an invalid in September 1857, at age 37, and took it upon herself to get better. She regained some strength a few months later and felt well enough to return to work. She herself suspected that she may not have fully recovered from her bout of Crimean fever, and she needed to give herself the time to recuperate from the illness in order to fully heal. • As she dealt with her illness, she entered a period of solitude, wishing not to be seen in such a “weakened” state by her peers or by government officials with whom she was still working on government reforms. She ate alone, moved into a hotel because it was quieter, and had her aunt act as intermediary between herself and the rest of the world, including her family. • Thanks to her efforts, “in the first 3 years of reform, the fatality rate of soldiers stationed in England fell to less than 50% of the number in earlier years, and the total mortality from all diseases dropped” as well (Dossey, 2000, pg. 218). • She was responsible for the creation of policies and Model Hospital Forms that would be used for consistent medical information record keeping, including the “Admission and Discharge Form,” the “Disease Specification and Incidence Form” (an updated list of classification of diseases), and the “Hospital Statistical Form” to track the number of patients with specific conditions who were “admitted, cured, dead, discharged, incurable, or discharged at their own request as well as the number of days hospitalized per case” (Dossey, 2000, pg. 224). • She published a book, Notes on Hospitals, in 1859, which focused on sanitary conditions in hospitals, hospital construction, civilian and military hospital organization, hospital design, and overall administrative reform (Dossey, 2000, pgs. 232-235). • Her second book, , was written “to help people care for themselves, their family, and their friends,” offering insight into care and illness prevention. It was published in January 1860, and became “a touchstone for the emerging profession of nursing. The first printing of 15,000 copies sold out within a month, and has stayed in print ever since (Dossey, 2000, pg. 238-239). • The Nightingale School of Nursing opened at St. Thomas’s Hospital on June 24th, 1860.

DID YOU KNOW? In 1883, Nightingale became the first recipient of the Royal Red Cross. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). (The London Gazette. 17 May 1904)

Nightingale (middle) in 1886 with her graduating class of nurses from St Thomas’ outside Claydon House, Buckinghamshire

• “When the broke out in April 1861…doctors soon wrote to Nightingale seeking advice on how to care for the sick and wounded troops” (Dossey, 2000, pg. 248). • “In December 1861, Nightingale developed severe spinal pain (today called spondylitis)” and suffered from that for 7 years. She continued to live in isolation and receive treatment for her illness, creating her own meal plans and remaining hyperaware of her guests’ activities and hospitality. She limited her contact with visitors and arranged to see people by appointment only (Dossey, 2000, pgs. 254-260). • Nightingale served as an authority on public sanitation issues in India as well, helping the British government to draft new policies and laws surrounding hospital sanitation status, army reports, and outlining sanitary progress. • “In 1861, Florence Nightingale decided to set up a new branch of her nurse’s training school that would instruct women from parishes to become trained midwives” (Dossey, pg. 310) • Florence Nightingale passed away unexpectedly following sudden drops in health on Saturday, August 13th, 1910, at her home in London. She was 90 years old. 3 REFERENCES • Biography. (2019, July 9). Florence Nightingale. Retrieved December 18th, 2019, from https://www.biography. com/scientist/florence-nightingale • Bostridge, Mark (17 February 2011). “Florence Nightingale: the Lady with the Lamp”. BBC. • Cover: The Lady with the Lamp. Popular lithograph reproduction of a painting of Nightingale by , 1891. • Dossey, Barbara (2000). Florence Nightingale. Springhouse Corporation. • Gill, Gillian (2005). Nightingales. Random House Trade Publications. • The London Gazette. 17 May 1904. p. 3185.

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