Florence Nightingale

01. Florence Nightingale

Born into a wealthy family, Florence overcame the narrow opportunities offered to girls of her station and, despite the censure of her family in 1851 she completed a course of nursing training in Germany.

Following reports in 'The Times' of the soldiers' suffering in the Crimean War (1854-56), Florence answered a government appeal for nurses and was appointed 'Superintendent of the Female Nurses in the Hospitals in the East'. Florence and her nurses improved medical and sanitary arrangements, set up food kitchens, washed linen and clothes, wrote home on behalf of the soldiers and introduced reading rooms.

Before Florence Nightingale nursing was not considered a respectable profession. With the exception of nuns, the women who worked as nurses were often ill trained and poorly disciplined. Most were working-class. Florence was determined to encourage educated, 'respectable' women into nursing. Her work in the Crimea set the standards for modern nursing and helped transform its public image. For the rest of her life she continued to campaign for improved sanitary conditions in both military and civilian hospitals.

02. Soldiers' suffering

The Crimean War has become infamous for military and logistical incompetence. The sufferings of the soldiers, from fighting, overwork, exposure and disease, were made worse by administrative collapse.

Troops ran short of rations, winter clothes, tents, medical supplies and fuel for cooking. Poorly clothed and lacking food and shelter, they soon succumbed to disease. There were not enough ambulances available to take the sick and wounded to Balaklava where they could embark for Scutari hospital, on the Asian side of Constantinople.

03. Death at Scutari

Those that reached Balaklava and survived the voyage to Constantinople found Scutari ill-equipped and the medical staff overwhelmed. Assistant Surgeon Henry Bellew of the Army Medical Department arrived at Constantinople on 2 January 1855 and was sent to Scutari. On 4 January, 120 new patients arrived:

'They were with few exceptions in a truly pitiable state of filth and utterly helpless from wounds and debility. On being brought inside the hospital several were found to be dead and others it was evident had but a short time to live. Almost all the living were in a lamentably exhausted condition and filthy to a degree not to be described. All were swarming with vermin, huge lice crawling all about their persons and clothes. Many were grimed with mud, dirt, blood etc and gunpowder stains. Several were more or less severely wounded and others were completely prostrated by fever and dysentery. The sight was a pitiable one and such as I had never before witnessed. The poor fellows endured their sufferings with heroic fortitude amounting in appearance to indifference to their fate…There has been somehow unaccountable neglect in the arrangements for this hospital. Until some hours after the arrival of the men there were neither stores, attendants nor the necessary refreshments on the spot. During this afternoon I attended single handed to the wounds and wants of 74 helpless men.'
(NAM 1951-12-21)

04. Press scandal

In February 1854, in his quest to provide the public with accurate information on the progress of the war, John Delane, the editor of 'The Times', asked the Irish-born journalist, William Howard Russell, to accompany the Brigade of Guards when it left Britain for the East.

His series of dispatches published in October 1854 describing the horrors of logistical collapse, poor medical treatment and the appalling hygiene at Scutari caused national outrage and eventually led to the downfall of the British government. They were also instrumental in persuading Florence Nightingale to gather together her party of nurses.

05. Journey to the Crimea

On 21 October 1854, five days after Sidney Herbert, the Secretary at War, wrote asking for her assistance, Florence Nightingale and her party of nurses left London for the East, crossing the Channel to Boulogne and travelling through France to Marseilles. From there she sailed on the fast mail boat 'Vectis' to Constantinople, where she arrived on 3 November. The manufacturer's details suggest that she acquired her field glasses – which are made of blackened brass - when in Marseilles. They are inscribed 'Miss Nightingale "Vectis" October 1854'.

06. Lady with the lamp

Florence used this lantern during her rounds at Scutari. At first, the male Army doctors did not want Nightingale and her nurses there and were contemptuous of their ability to help. They also interpreted her opinions as an attack on their professionalism.

After the arrival of fresh casualties from the Battle of Inkerman in November 1854, the staff were soon fully stretched. They now accepted the nurses' aid. Florence soon became something of a celebrity.

One of the main creators of the Nightingale cult was Henry Wadsworth Longfellow who immortalised her as the 'Lady with a Lamp' in his poem Santa Filomena:

'A Lady with a lamp shall stand.
In the great history of the land,
A noble type of good,
Heroic Womanhood.'

07. Improvements at Scutari

In this night scene, Florence is shown on her rounds of the cramped wards at Scutari. In what was to become an iconic image of her, she is seen holding a lamp in her hand.

Despite her hard work, by February 1855 the death rate at the dirty and vermin-ridden hospital had risen to 42 per cent. She and her nurses greatly improved the comfort of the men at Scutari, but the unventilated building sat on top of a damaged sewer so disease remained a problem. Florence mistakenly blamed the high number of deaths on inadequate nutrition, not on poor sanitation. The death rate at Scutari only dropped after the sanitary commission repaired the sewers and improved the ventilation.

08. More changes needed

Florence wrote to Lord Raglan, the British commander in the Crimea, from Scutari pointing out deficiencies in medical arrangements for the sick and wounded:

'The comforts of the sick do not depend so much upon the skilful surgeon even, as upon the careful orderly, and the constant change of these continually neutralizes the orders of the former. My Lord, I know well that what I am going to suggest may be simply impossible. But I also know that hundreds of lives may depend upon it. Two things occur to me as desirable. (1st) An exceptional Order for the moment from the Commander in Chief that the Convalescents, if good Orderlies, be not sent away to the Crimea.

(2nd) That the Commander in Chief call upon the Commanding Officers to select ten men from each Regiment as Hospital Orderlies to form a depôt here (not young soldiers, but men of good character).

Also three Sergeants from each Regiment, for upon the non-commissioned officer, who now is recalled as soon as he begins to learn his duty when placed in charge of a ward, depends most of the good order of that ward.'

09. Burgoyne's distrust

Although Lord Raglan was sympathetic to Florence, others were less enthusiastic. Burgoyne wrote:

'The hospitals appear to me to be in excellent order, and without wants of any kind unprovided for; the patients have generally that kind of countenance that indicates amendment, rather than despondence. There is however manifestly an under current of troubles and turmoils in the establishments. Miss Nightingale is decidedly not in favour with the authorities, and from the accounts I hear of her I can hardly wonder at it.

Whatever philanthropy she may have on a great scale, she does not appear to be amiable in ordinary intercourse with her equals or superiors. She likes to govern, and bestows all her tenderness upon those who depend upon her: for instance, she will not give an atom or a thought upon any Officer who may be in the most wretched state. She seems also to court popular applause, even unduly. If anything is wanted for the sick, she will hurry to provide it from her own funds and stock for fear it might be obtained in the regular course. She is considered also very hard, seems to delight in witnessing surgical operations, with arms folded, and where she can be of no use whatever, and is considered to be of that strong minded class of woman, that is indifferent on religion.'

10. Florence taken ill

On 2 May 1855, Florence left the hospital in Scutari in order to witness for herself the conditions of the Army at Balaklava. Within a few days of her arrival in the harbour, she was struck down with 'Crimean Fever'. Although it was feared that she was near to death, by 24 May Lord Raglan was able to telegraph London that she was out of danger. However, her recovery was slow, hampered in part by her demanding schedule. In a letter to Sidney Herbert, Secretary at War, she recalled that, 'During the greater part of the day I have been without food necessarily, except a little brandy and water (you see I am taking to drinking like my comrades in the Army)'.

11. New transport

On her second visit to the Crimea in March 1856, the exertion of travelling to the scattered field hospitals took its toll on Florence's delicate health and, to spare her riding, she was given a mule cart. This however overturned one night on the rough tracks and so Colonel William McMurdo of the Land Transport Corps presented her instead with this, her Crimean carriage, which also served as an ambulance. The original carriage is in the Collections of the Florence Nightingale Museum Trust.

12. Sanitary Commission

Florence was not the only person to respond to the press scandal about conditions in the Crimea. Lord Palmerston's new government also formed a commission to inquire into the sanitary condition of the Army of the East. It consisted of Dr John Sutherland, Dr H. Gavin and Robert Rawlinson, a sanitary engineer. They reached Constantinople in March 1855 and helped reduce the death rate in the hospital at Scutari by half within weeks. Continuing on to the Crimea, the commission's measures to overhaul sanitary conditions in the field hospitals and camps proved equally successful.

13. Training at St. Thomas' Hospital

This photograph of Florence was taken on her return from the Crimea in August 1856. In the years that followed she continued to campaign for the reform of nursing and for cleaner hospitals. By 1859 well-wishers had donated over £40,000 to the Nightingale Fund. Florence used this money to set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860. Once the nurses were trained, they were sent to hospitals all over Britain, where they introduced her ideas. Florence also published two books, 'Notes on Hospital' (1859) and 'Notes on Nursing' (1859) that laid the foundations of modern nursing practice.

14. Florence as icon

This bust was paid for and presented to Florence by the Non-Commissioned Officers and Men of the British Army. Publicity-shy and appalled at the adulation she received, when asked to lend this bust to the Victorian Era Exhibition, held to commemorate Queen Victoria's 1897 Diamond Jubilee, Florence initially refused but eventually relented. Confirming her worst fears, the bust was sacriligiously venerated by visitors almost as a holy relic. Nevertheless, she was touched by the report that an anonymous visitor, possibly a veteran of the Crimea, came every day to dress it with fresh flowers.

15. Royal approval

Sometimes referred to as the 'Nightingale Jewel', this brooch, the design of which was supervised by Prince Albert The Prince Consort, is engraved with a dedication from Queen Victoria, 'To Miss Florence Nightingale, as a mark of esteem and gratitude for her devotion towards the Queen's brave soldiers, from Victoria R. 1855'. The brooch was not intended to serve merely as a piece of jewellery, but rather, in the absence of a medal or established decoration suitable for presentation to such a female civilian, it stood as a badge of royal appreciation.

16. Sultan's gift

This magnificent diamond and cornelian stone bracelet was presented to Florence by the Sultan before her return to Britain on 28 July 1856. The gift was accompanied by a financial donation for the nurses and hospitals. In a letter from Queen Victoria to the Secretary of State for War, Fox Maule, 2nd Baron Panmure, dated 27 July 1856, the Queen refers to Nightingale's application for permission to accept these presents:

'The Queen returns this letter of Miss Nightingale's. She had already heard of the gifts of the Sultan's, through Lord Stratford, who communicated with Lord Clarendon on the subject, and asked the Queen's permission for Miss Nightingale to accept the bracelet, as well as the sum of money for the Nurses and Hospitals. The Queen entirely approves of the intended distribution of the money.'

On her death in 1910, this bracelet was one of a number of items, along with the 'Nightingale Jewel' and the marble bust of Florence, that were donated to the Royal United Service Institution by the executors of her estate, in accordance with her desire that they should be 'where the soldiers could see them'.

17. Soldiers' affection

The contemporary fame of Florence Nightingale was reflected in the production of merchandise commemorating her achievements. This depiction of Florence helping a wounded soldier is a typical example, and one that reflects the genuine respect and affection in which the common soldiers held her. As well as caring for the sick and wounded Florence wrote letters for the soldiers and sent many letters to the families of those who had died at her hospital.

18. Public adulation

This mug is decorated with an illustration of 'The Nightingale Jewel', the brooch given to Florence Nightingale by Queen Victoria in 1855. The contemporary fame of Florence was reflected in the production of merchandise commemorating her achievements. Florence herself was publicity-shy and was appalled at the adulation she received, but this did not prevent the development of a whole industry based on her 'celebrity'.

19. Royal Red Cross

At the time of the Crimean War nurses were not considered eligible for campaign medals; the Zulu War of 1879 was the first campaign in which their services would be so recognised. However, Florence Nightingale was among the first 31 recipients of the Royal Red Cross, instituted in 1883 as an award specifically to females for special devotion in nursing sick and wounded servicemen.

20. Further recognition

The Most Venerable Order of the Hospital of St John of Jerusalem was incorporated by Royal Charter of Queen Victoria in 1888. It is generally given in recognition of voluntary work in hospitals, ambulance and relief work. It has undergone many changes and is now divided into six classes under the Sovereign and Grand Prior of the Order. The Order was presented to Florence Nightingale in 1904.

21. Order of Merit

Since its institution in 1902, the Order of Merit has to date only admitted eight women, of which Florence Nightingale was the first. This highly prestigious Order, of which British membership is limited to the Sovereign and a maximum of 24 others at any one time, comprises six admirals, six generals and twelve civilians eminent in the fields of art, music and literature.

22. Final years

In her later life Florence suffered from what is now known as Chronic Fatigue Syndrome. Yet despite being bedridden for many years, she still campaigned tirelessly to improve health standards. Florence died on 13 August 1910 aged 90. Her relatives declined the offer of burial in Westminster Abbey, and she is buried in the graveyard at St. Margaret Church in East Wellow, near her parents' home.