Personality - Florence Nightingale

INTRODUCTION
The vision of Nightingale walking in the wards, lamp in hand, nursing the wounded, is romantic. But the reality was not. The romanticism of the stories woven around Nightingale’s life, were overshadowed by the pathetic conditions of the wards that lacked comforts and where basic medical supplies were all but absent.

BIRTH AND FAMILY HISTORY
Florence Nightingale, the daughter of William Edward and Frances Nightingale came from a wealthy family. William Nightingale had been born with the surname Shore. He had changed it to Nightingale after inheriting from a rich relative, Peter Nightingale of Lea, near Matlock, Derbyshire. Her parents were on a tour to Europe where their daughters were born. Their first daughter was born in Naples and was named Parthenope, the Greek name for Naples. Florence too was named after her birthplace. Florence was born on May 12, 1820 while Parthenope was born a year earlier on April 19, 1819. When Nightingale was about five years old, her father bought a house called Embley near Romsey in Hampshire. This now meant that the family spent the summer months in Derbyshire, while the rest of the year was spent at Embley. Between these moves were trips to London, the Isle of Wight and to relatives. Both Parthenope and Florence were educated by their Cambridge University educated father. Florence Nightingale learned Greek, Latin, French, German, Italian, history, philosophy and mathematics. She grew up to be a lively and attractive young woman. Admired in the family’s social circle, she was expected to make a good marriage. But Florence knew the course of her life.

CHILDHOOD
Florence had a sickly childhood. The climate of England did not suit her, after that of Italy (Florence) where she was born. Florence was delicate, yet graceful with thick bright chestnut hair and a delicate complexion. They had a few cousins staying with them. She could never like the plays of other children. Her childhood was filled with gardens to play, ponies to ride and dogs, cats and birds to be looked after. She was strange, passionate, wrong-headed, obstinate and miserable. She was so uncommon that she doubted her capacity to behave like other people, and refused to dine downstairs, convinced that she would betray herself by doing something extraordinary with her knife and fork. But the happiest time of her life was during a year's illness, which Florence had when she was 6 years old. She never learnt to write till she was 11 or 12, owing to weakness in her hands. At 7 years of age, she had a governess, who brought her up most severely. She was just and well intentioned, but she did not understand children and she used to shut Florence up for 6 weeks at a time. On the contrary, she spoilt her elder siser Parthenope.

EDUCATION
When Florence was 10, her mother would have no more governesses and William took up the task of teaching both his daughters. He taught Florence Latin, Greek, mathematics and whatever he knew himself. Florence had the most enormous desire of acquiring. For 7 years of her life she thought of little else but cultivating her intellect.

Florence had also the strongest taste for music. But God was not merciful to her and took away her voice by constant sore throat. Music excited her imagination and passionate nature so much, that she recognized it as a real blessing.

FLORENCE AND GOD
God had always led her. She remembered no particular sermon or circumstances which ever made any great impression upon her. But the first idea she could recollect when she was a child was a desire to nurse the sick. Her day dreams were all of hospitals and she visited them whenever she could. She never communicated about it to any one, as she knew it would have been laughed at. She thought that God had called her to serve Him in that way.

TURNING POINT
Unconcerned with the conventions of the Victorian society, young Florence was frustrated with her social life. Florence, a 17-year-old beautiful girl could not think of young handsome boys, but to serve her nation by her inner urge of motherhood. She could frequently keep in unison with God by talking tohim. Roaming in the gardens of Embley,

she felt that she had heard a divine voice to undertake a mission. She noted in her private diary that God spoke to her and said that she was sent for His service. On February 7, 1837, she wrote, "God spoke to me and called me to his service" but she is not clear on how to "serve" Him. It was her first encounter with God as an inward revelation as it had happened to Joan of Arc. At the age of 16 Joan had heard the voice of nature – "Go, go, daughter of God, into the realm of France. You must drive out the English and bring the king to be crowned." This event was the turning point in Florence's life.


FLORENCE AND LOVE OF MATHEMATICS
In September 1837, the family travelled to Europe while their house in Embley was being remodeled. In April 1839, the family returned to England. The next year, her aunt tried to arrange math lessons for Florence but her mother resisted the idea saying that ladies didn't need math. Although her father loved mathematics and had bequeathed this love to his daughter, he urged her to study subjects like Italian, Latin, Greek, history, and mathematics that were more appropriate for a woman. After many long emotional battles, her parents finally gave their permission and allowed her to be tutored in mathematics. Her tutors included James Sylvester, who developed the theory of invariants. Florence was said to be Sylvester's most distinguished pupil. Lessons included learning arithmetic, geometry and algebra and prior to Nightingale entered nursing, she spent time tutoring children in these subjects.

NURSING AS A CAREER
Florence Nightingale was involved with philanthropic and social work in England from an early age. In 1842, Florence met Richard Monckton Milnes, a philanthropist. In 1844 she visited many hospitals and reformatories in Europe. In the same year Florence asked Dr Howe (author of Battle Hymn of the Republic), an acquaintance at Lea Hurst if it would be OK for her to "devote herself to works of charity in hospitals and elsewhere as Catholic sisters did ?" Later in that year, her cousin, Henry Nicholson put forward a marriage proposal, but Florence declined his offer. In early 1845, Florence expressed her desire to work and train at Salisbury Infirmary nearby. Frances and Parthenope were horrified as it was considered unsuitable for women to enter the profession of nursing. A cultured lady of those days could not even think of entering a hospital to work. Nurses of those time lacked in training and they also had the reputation of being coarse and ignorant women, given to promiscuity and drunkenness. In 1846, she became a self-taught expert on hospitals and sanitation.

During the Spring of 1847, Richard Monckton Milnes proposed to Florence, but to no avail. Later that year, Selina and Charles Bracebridge, their family friends took her to Rome with them as she was ill. There, she met Elizabeth and Sidney Herbert and in 1848, she attended the opening of Sidney Herbert's Charmouth Convalescent Home. It was here, that Florence's expertise in nursing was recognized. In 1849, Florence finally said no to Richard's proposal of marriage. After pondering over for long, she concluded that she could not have "work" of her own if she chose to follow her heart into marriage. It would destroy her chance of serving God's call.

FLORENCE AT KAISERWERTH
In December 1849, she accompanied the Bracebridges on a trip down the Nile in Egypt and Greece. After the trip up and down the Nile, Florence and the Bracebidges toured Europe. In early August 1850, she visited the Institution of the Protestant Deaconesses at Kaiserswerth on the Rhine for the first time. At the end of her visit, Rev. Pastor Theodore Fliedner asked her to write a pamphlet on "The Institution of Kaiserwerth." She did so but declined credit for the pamphlet. From July 6 to October 7, 1851, she was again at Kaiserswerth not as a guest, but as a probationer (student). She trained as a nurse at the institute and on her return to England in 1853, she devoted herself to the Governesses' Sanatorium in connection with the London Institute.

Florence wrote Cassandra in 1854. According to Florence, Cassandra was a mean by which every individual could achieve self-fulfillment and serve God. In March, God again spoke to Florence and said "You would do good for Me alone without your reputation." So she decided to serve Him by serving the "sick poor". The misery and squalor near her summer abode, Lea Hurst, made her uncomfortable. She decided to work for the needy and neglected. Florence visited the homes of the sick in local villages and often investigated the workings of hospitals and nursing homes. Florence went into residence in her first "situation" as superintendent of An Establishment for Gentlewomen During Illness at 1, Upper Harley Street, from August 12, 1853 to October 1854.

THE CRIMEAN WAR
The Victorian era was an age of Industrial Revolution and Crimean War. In March, 1854, Britain, France and Turkey declared war on Russia. The medical facilities provided to the soldiers were extremely poor. The Times, a powerful newspaper of Britain, on October 12, 1854 printed, "It is with feelings of surprise and anger, that the public will learn that not sufficient preparations have been made for the proper care of the wounded. Not only are there not sufficient surgeons – that, it might be urged, was unavoidable; not only are there no dressers and nurses – that might be a defect of system for which no one is to blame; but what will be said when it is known that there is not even linen to make bandages for the wounded ?" The news on the following day read, "No blame is due to the medical men or the officers in command. They work early and late, are worn and harassed, and feel as much pity as any one for the unfortunate dying creatures; but our whole medical system is shamefully bad. The worn-out pensioners who were brought out as an ambulance corps are totally useless, and not only are surgeons not to be had, but there are no dressers and nurses to carry out the surgeon’s directions and to attend on the sick during the interval between his visits. Here the French are greatly our superiors. Their medical arrangements are extremely good, their surgeons more numerous, and they have the help of the ‘Sisters of Charity’, who have accompanied the expedition in incredible numbers. These devoted women are excellent nurses, and perform for the sick and wounded in all the offices, which could be rendered in the most complete hospitals. We have nothing. The men must attend on each other, or receive no relief at all."

Such was the condition of the wounded warriors, who left their home and families to serve the nation. While there was so critical a moment on one hand, the Army authorities on the other, were not ready to admit female nurses into military hospitals. Mr Sidney Herbert, the Secretary for War, knew what to do in those adverse circumstances. He knew Florence, and sought her help. He wrote a letter to her, which read, "There is but one person in England that I know of who would be capable of organizing and superintending such a scheme; and I have been several times on the point of asking you…My question simply is would you listen to the request to go and superintend the whole thing ?"


ACCEPTING THE CHALLENGE
Florence too was eager to accept such a challenge. After she returned to England from Germany, she secretly studied every aspect of hospital administration and sanitation. She was a qualified nurse and a good administrator. Without losing a moment’s time, she agreed to Herbert’s request, on the understanding that all who went with her, obeyed her orders and were not answerable to anyone else.

Nightingale approached Miss Sellon for help. Nightingale knew that Sellonite Sisters had an experience in nursing during the cholera epidemic in Plymouth. The Sisters were summoned, anonymously, to reach London. Sister Margaret Goodman received a telegram, which read, "Let nothing prevent your reaching London tomorrow morning." Sister Sarah Anne Terrot, Sister Bertha Turnbull and Sister Amelia Warren, of the same sisterhood caught the mail train leaving Plymouth. Sister Goodman joined them at Totnes. At Bristol, Sister Clara Sharpe joined them. No one knew where and why they were going. The sisters reached London the next morning. They went to Osnaburgh Street off Euston. They were welcomed, but their curiosity was not satisfied. After some time, Sister Terrot was ushered into Miss Sellon’s room. She was ill and exhausted. In a faint voice she asked Sister Terrot, "Our soldiers in the East want nurses. Some are going. I want to send eight – are you willing to be one ?" The answer was "Yes", and the interview ended.


OFF TO SCUTARI
The Times, on October 21, 1854 printed, "We are happy to be enabled to announce that, under special arrangement with the Peninsular and Oriental Company, a number of surgeons, and the staff of nurses organized by Ms Nightingale, will embark on the 27th instant, on board the Vectics, and be conveyed by that vessel to Constantinople immediately after the delivery of the outward India mail at Malta." Nightingale was to join the sisters and other nurses at Paris. The voyage from London to Scutari, through Folkestone, Bouglone, Paris, Lyons, Valence, Marseilles, Malta and Dardanelles was a terrifying one. The party had to face great difficulties as storms and heavy rainfalls were a routine. They were all wet, as the Vectics was not built strong enough to challenge the hard and rough weather of the sea. With rare meals and death of Sister Clara Sharpe, they all finally landed on Scutari. The view of the Barracks Hospital at Scutari, obviously, was disappointing. Sister Goodman was horrified to see "Small bands of our poor men, half-starved, pain-worn, ragged beings, crossed our path now and then as we proceeded to our quarters, raising their languid heads to gaze upon us with surprise."

INITIAL RESISTANCE
But all this was bearable. What was unbearable was the insult that they were unwanted. The Army Medical Department had stated that female nurses were "an unwise indulgence, unfavorable to medical discipline and to the recovery of the patients." Being a female meant Nightingale had to fight against the military authorities at every step, she went about reforming the hospital system. With conditions like soldiers lying on bare floors surrounded by vermins and the unhygienic operations taking place, it was not surprising that when Nightingale first arrived in Scutari, diseases such as cholera and typhus were rife in the hospitals. This meant that injured soldiers were 7 times more likely to die from disease in hospital, than on the battlefield.

Nightingale’s real action started here. She had to play her cards carefully. She knew that some doctors were not against her. She wanted to avoid scenes in the wards, so she never pushed herself and her nurses into the wards. She gave her nurses the instruction, "only to attend to patients in the wards of the surgeons who wished for our services" and "never to do anything for the patients without leave of the doctors." The nurses had to sew shirts, make pillows and mattresses. From October 27 to November 5, the services of nurses were not accepted. But on November 5, 1854, the Russians attacked the English line at Inkerman. The Russians were 50,000 in number whereas only 8,000 British soldiers fought back. Within six hours 2,500 British soldiers were wounded.

THE PITIABLE CONDITIONS
The conditions in the hospital were unnerving, as the wounded were admitted into the Barracks Hospital. Stretchers were provided for the wounded who were quite disabled, but many others walked from the ship to lie down on straw pallets to die. There were no beds and no bedroom furniture. Empty beer bottles served as candlesticks.

INTO ACTION
The doctors were not able to cope up with the number of soldiers. At last, the barriers were broken. Florence Nightingale and her nurses moved into action. Nightingale had a lot to do. She wrote in a letter to her friend, a doctor that, "The wounded are now lying up to our very door… Let no lady come out here who is not used to fatigue and privation… We have no room for corpses in the ward… I am getting a screen now for the amputations, for when one poor fellow… sees his comrade today die under the knife, it makes impression and diminished his chance."

In spite of such sorry conditions, Nightingale and her nurses worked hard. There was no food for the soldiers. Sister Elizabeth Wheeler, a Sellonite Sister, struggled to get extra diet for her patients. This made things worse for Nightingale. Sister Wheeler was unfortunately, sent back to England. Popularly known as "Lady-in-Chief", Florence Nightingale wrote home on behalf of soldiers, acted as a banker, sending the men’s wages home, and introduced reading rooms to the hospital.

IMPROVING THE SANITARY CONDITIONS
Nightingale collected data and organized a record keeping system. This information was then used as a tool to improve city and military hospitals. Nightingale's knowledge of mathematics became evident when she used her collected data to calculate the mortality rate in the hospital. These calculations showed that an improvement of the sanitary methods employed would result in a decrease in the number of deaths. By February 1855, the mortality rate had dropped from 60 per cent to 42.7 per cent. Through the establishment of a fresh water supply as well as using her own funds to buy fruit, vegetables and standard hospital equipment, the mortality rate in the spring had dropped further to 2.2 per cent.

Nightingale did all that was possible for her to do. A doctor at the Barracks Hospital commented, "The cold reception accorded to these courageous and noble-hearted women was soon changed to a feeling of thankfulness for their assistance and reverence for the self-sacrificing way in which they did their good work." Florence Nightingale and her staff of 38 nurses witnessed the disasters of the war, in the form of wounded soldiers and their sufferings. Her words and works soothed the soldiers. She gained undying respect from them. To show the nation’s gratitude for her hard work, a public subscription was organized in November 1855. The money collected enabled her to continue her reform of nursing in the civil hospitals of Britain.

FELLOWSHIP
These unsanitary conditions, however, were not only limited to military hospitals in the field. On her return to London in August 1856, four months after the signing of the Peace Treaty on March 30, 1856, Nightingale discovered that soldiers during peace time, aged between 20 and 35 had twice the mortality rate than that of civilians. Using her statistics, she illustrated the need for sanitary reform in all military hospitals. While pressing her case, Nightingale gained the attention of Queen Victoria and Prince Albert as well as that of the Prime Minister, Lord Palmerston. Her wishes for a formal investigation were granted in May 1857 and led to the establishment of the Royal Commission on the Health of the Army. The Sepoy Rebellion of India in 1857, called her attention to sanitation problems in India and she began a life-long project to sanitize India. This was the beginning of her illness, post-traumatic stress disorder (PTSD). After this period (of collecting facts for the commission) she was reclusive, mostly bedridden and only met people by appointment. After her return from the Crimean War, she never made a public appearance, never attended a public function and never issued a public statement. In 1858, for her contributions to army and hospital statistics, Nightingale became the first woman to be elected to be a Fellow of the Royal Statistical Society.

POST WAR EFFORTS
In the post war period, she studied new designs for modern hospitals all over Europe, in order to help the army reform its health and sanitary systems. In Paris she found a revolutionary design in which separate units or pavilions, made up one large hospital. By making a pavilion with well-equipped sunlight and fresh air the hospital minimized the spread of infections. She later succeeded in promoting this design in England. The Scutari Hospital at Turkey was a very small part of her 50-year career.
Even after finishing off her work at war, her dedication towards army was the same. In her private note, she remarked – "Oh my poor men who endured so patiently. I feel I have been such a bad mother to you to come home and leave you lying in your Crimean grave. Seventy-three per cent in eight regiments during six-months from disease alone who thinks of that now ? But if I could carry and one point which would prevent any post of the recurrence of this our colossal calamity then I should have been true to the cause of those brave dead."

The illness did not stop her, however, campaigning to improve health standards. In 1859 she published a small booklet titled Notes on Nursing. It became very popular. It was expanded and published again in 1860 and in 1861 with special section on taking care of babies. This was the first textbook specifically for use in the teaching of nurses and was translated into many languages. This book sold millions all over the world and the only money she ever earned in her life were her royalties from this book. In 1862, she published her Observations concerning sanitation problems in India. She published 200 books, reports and pamphlets. Nightingale's other published works included Notes on Hospitals (1859) and Notes on Nursing for the Labouring Classes (1861).

NIGHTINGALE TRAINING SCHOOL
In 1860, after five years of grueling work, she completed a voluminous report that resulted in the development of an Army Medical School in addition to greatly improved army barracks, hospitals and living conditions for soldiers. In the same year, the Nightingale Training School and Home for Nurses based at St Thomas' Hospital in London, opened with 10 students. It was financed by the Nightingale Fund, a fund of public contributions set up during Nightingale's time in the Crimea and had raised a total of £50,000. It was based around two principles. Firstly that the nurses should have practical training in hospitals specially organized for that purpose. The other was that the nurses should live in a home fit to form a moral life and discipline.
The opening of this school marked the beginning of professional education in nursing. Florence Nightingale's contributions to the evolution of nursing as a profession were invaluable. Before she undertook her reforms, nurses were largely untrained personnel who considered their job a menial chore. Through her efforts, the stature of nursing was raised to a medical profession with high standards of education and important responsibilities. The foundation of this school enabled Nightingale to transform nursing from its disreputable past into a responsible and respectable career for women. Nightingale responded to the British war office's request for advice on army medical care in Canada and was also a consultant to the United States government on army health during the American Civil War.



WORK TAKING ITS TOLL
By the end of 1861, she fell ill and doubted that she would die by sickness. Sickness remained with her for years together and as a result she could not walk for six years. For this period she had to be carried from room to room. But even this did not deter her from serving the sick and helpless patients. In 1864, she constantly worked on setting up home nursing system, barracks for married soldiers, hospitals for the insane and poor. She helped to stop the practice of putting all sick poor together – men, women, children, sane and insane. She constantly worked on rural hygiene, high death rate in childbirth and sanitary problems of India. But her health did not cooperate any longer for his wish to serve the deprived and poor class of India.

Nightingale’s opinion on how to best build hospitals was constantly being sought. She wrote Notes on Hospitals in 1863. Her concept for hospitals was simple : "It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary nevertheless to lay down such a principle." Many of the things she endorsed would be considered basic today : drainage; ventilation; non-absorbent floors, walls, and ceilings; and sanitation. She favored a pavilion plan in which infections would be prevented by creating separate pavilions, or wings, for specific diseases. She also stressed the need for designs that allowed the nurse to be able to see every patient in his or her wing.

While medical knowledge has significantly increased since Nightingale's time, her common sense and wisdom still forms a solid basis for caring for people. She believed, first and foremost, in hygiene (fresh air, cleanliness, clean water, proper drainage, and plenty of light) and constant consideration for the patient's feelings. In one particularly empathetic passage, she addressed the importance of a quiet environment : Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient. It is rarely the loudness of the noise, the effect upon the organ of the ear itself, which appears to affect the sick.

In 1867, she began working on rural hygiene, deaths in childbirth and Indian sanitary questions. She was soon exhausted and found it difficult to concentrate. In 1871, she published Notes on Lying in Hospitals. Henri Dunant, the founder of Red Cross said that Nightingale had greatly influenced his work and life.


LAST YEARS
In January 1874, her dear father died while her mother died in February 1880. Nightingale constantly struggled during this period. In 1883, her childhood companion and sister Parthenope started suffering from arthritis and Nightingale took her sister under her care. All the care and love she had bestowed over the general public was now being showered on her loving sister. In 1887, she worked on and formed the British Nurses Association. She dedicated herself to the cause of the unfortunate, the weak, the suffering, the defenseless and it was a matter of indifference to her whether they happened to be women or men. Her only motto of life was – to help the needy and the destitute.

Despite taking all possible care, her sister died in 1890. This took away her remaining energy also. She confined herself within her bedroom forever. In 1896, Florence was confined to her bedroom – this time, permanently. In 1902, Florence could no longer read or write except with great difficulty. She finally accepted the services of a companion, housekeeper and a secretary for the rest of her life. In November 1907, King Edward VII bestowed the Order of Merit on Florence and it was for the first time that the Order was given to a woman.

DEATH
Florence Nightingale died at her home, 10 South Street, in London, on Saturday, August 13, 1910. News of her death spread quickly throughout England and across the oceans to the other countries of the world. Her courage and devotion had not been forgotten.

"She merits the finest funeral we can give her," wrote one newspaper editor. "We have been blessed with two queens in our British Empire – Victoria and Florence."

However, her will indicated that she wished her body to be donated to medical science for examination, then "carried to the nearest burial ground accompanied by not more than two people without trappings." A compromise was then reached upon. It was then decided that there would be no national funeral or burial in Westminster Abbey, but neither was the body donated to medical science.

Six British sergeants, dressed in formal military wear, carried the coffin to a grave beside those of Florence’s mother and father near Embley Park. The courtyard of St Margaret’s East Wellow was filled with bright, cheerful flowers, just as it had been many many years before when Florence was a little girl. Men, women, and children – many of them poorly dressed – stood quietly.

In the afternoon sunlight, a powerful hymn blossomed out among those present. The words of "The Son of God Goes Forth to War" added strength and power to the moment. It had been one of Florence’s favorite hymns. Her tombstone read simply, "F.N. 1820-1910". In 1915, the Crimean Monument in Waterloo Place, London, was erected in her honor.

NIGHTINGALE – THE LEADER
If we combine all the roles Nightingale played, we clearly have a leader and a role model for nurses. There’s some role, experience, or lesson from Nightingale to be learnt by everyone. As she led nursing in her own time, so does her legacy lead us into the new millennium.

If Nightingale were here today, she would, no doubt, have challenged us by repeating the challenge she made in her annual address to the probationers and nurses of the St. Thomas School in 1872 : "For us who Nurse, our Nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it, we are going back."

She would also add, as she did in an address in 1893, that "no system can endure that does not march. Are we walking to the future or to the past ? Are we progressing or are we stereotyping ? We remember that we have scarcely crossed the threshold of uncivilized civilization in nursing: there is still so much to do."