Florence Nightingale - The Lady with the Lamp

If I were to ask you to name a famous nurse, there's a very good chance you'd respond with the name of a 19th century woman. Florence Nightingale is almost the archetype of nurses. A wealthy woman who gave it all up to devote herself to caring for the sick, she's still pictured today as she was during her heyday in the Crimean War, carrying a lamp from sick bed to sick bed, tending to the wounded. But how many of us know the woman behind the myth? Born into privilege in the early 19th century, Florence Nightingale was a polymath genius who spoke multiple languages and pioneered concepts of statistical analysis that are still used today. A shy, devout Christian, she was a feminist who thought women shouldn't vote, a celebrity who wished only to be forgotten, and a nurse who oversaw a hospital with one of the highest death rates in modern history. A complex woman full of contradictions, this is the life of Florence Nightingale. What words spring to mind when you hear the name Florence Nightingale? We're guessing it's something along the lines of nurse, or angel, and probably lamp. What probably don't spring to mind are words like borderline genius. Born on May 12, 1820 to English parents in the city of Florence, no prizes for guessing where she got her name, Florence Nightingale had the sort of brain that only comes along once in a generation. Her parents were super connected, super wealthy English socialites who valued education even for their two daughters. This was kind of a big deal at the time, when being born with two X chromosomes was the quickest shortcut to a life of knitting, wearing corsets, and fainting whenever someone mentioned long division. Luckily for baby Florence, her father had always dreamed of passing on his own Cambridge education to his children, and he'd be damned if he was going to let those children being female stop him. There's actually some evidence that Papa Nightingale had expected Florence to be a boy, and he refused to accept reality. He encouraged the villagers on his estate to refer to the young girl by the male title of squire. Regardless, Florence's early life was spent in a blitz of learning that would leave an honest student's head spinning. She mastered French, German, Greek, Italian, and Latin. She memorized works of philosophy and would debate them with her father. She also got super into maths, to the extent that she begged her parents to let her go study the subject at university, but her mother said no. It was not long after that Florence had a vision. Now, we really need to be careful with the word vision here, because that conjures images of Joan of Arc communicating directly with God. Florence's vision wasn't like that. It was, more than anything, a bit of a feeling and a certainty that God had given her a silent command. Still, the effect was dramatic. On February 5, 1837, the 16-year-old Florence declared God had told her to end suffering in the world. She interpreted this to mean she should go into nursing. This time, her mother and her father both told her no. In those days, nursing was considered barely above prostitution. The idea that an upper-middle class girl could go into the profession was so radical that even Florence's liberal father refused to consider it. But if Mom and Dad thought they could keep Florence from her calling, they had another thing coming. Over the next 13 years, Florence tried again and again to change her parents' minds. In 1844, Florence tried and failed to convince her parents to send her for nurse training in Salisbury. In 1849, she even ditched a long-term suitor, Richard Monckton Milnes, so that she could focus on her non-existent career. By the way, random aside, it later transpired that this suitor was heavily into sadomasochism, so maybe she dodged a bullet there. But Florence was persistent, and she kept working away at her parents all the way through her teenage years, right into womanhood. By the time 1850 rolled around, she was 30 and her father was utterly worn down. That July, her parents gave her permission to travel to Germany for a two-week training course at a nursing hospital. Perhaps they thought that being up close with all that disease would put her off a life of nursing. But that didn't happen. The next year, Florence returned for another course, this one lasting three months. By 1853, Florence's dream had finally been realized. Using her family connections, she got a job at a hospital for distressed gentlewomen on Harley Street in London. It wasn't hugely taxing, but it was definitely nursing. Finally, Florence Nightingale had made it. It was just the warm-up act. Florence Nightingale didn't know it yet, but she was about to get sucked into one of the bloodiest conflicts in European history. In 1853, the European continent was haunted by the specter of a sick man. The Ottoman Empire had once been one of the finest empires history ever produced. At its height, it was an epicenter of science and art, capable of taking territory all the way up into Austria. By 1853, its glory days were over. Hobbled by stagnation, secession, and wars of independence, the Ottoman Empire was now staggering on the fringes of geopolitics, being known as the Sick Man of Europe. As the invalid empire hacked away on its deathbed, another empire sensed an opportunity. In the Russian capital, it was lost on absolutely no one that a dying Ottoman state meant a chance to snatch territory from the empire's fringes. At the same time, in Paris and London, it was lost on absolutely no one that a territory-hungry Russia posed a real threat to all of them. In October of 1853, all these different strands finally came together. Under a pretext of defending Orthodox Christians living in the sick empire, Russia made its move. The Turks declared war, which pulled in Britain and France, and suddenly the area around the Black Sea was alight with conflict. It was the start of the Crimean War, and it would end somewhere in the region of a million lives. We could easily spend the next 20 minutes describing this complex, forgotten war. But for our purpose today, there are two things you need to understand about the Crimean War. The first is that this is the first war in which the modern media was involved. The first war correspondent in history, William Howard Russell, was there for the Times of London, sending back real-time reports via the newly invented telegraph. The second is that military hospitals were very different from what we would expect now. Nursing soldiers during wartime wasn't something governments did. Since medieval times, it had usually been religious orders, like the Sisters of Mercy, who took care of the wounded. When the Crimean War erupted, though, the British government was so against the idea of sending women into a conflict zone that they actually forbade any nurses from going. This meant the injured British troops were receiving a level of care that was so basic you could program computers with it. The upshot is that these two points overlapped when William Howard Russell decided to write about British military hospitals in Crimea and send back reports so graphic that they caused outrage. Caught back-footed, the British government quickly reversed its No Nurses on the Front Lines policy. Suddenly, Secretary of State at War Sidney Herbert found himself in dire need of a head nurse to send to Crimea. Luckily, he had just the woman in mind. Many years earlier, in the 1940s, Herbert and his wife Elizabeth had been visiting Rome when they happened to bump into a vacationing Florence Nightingale. The three hit it off and remained close friends when they returned to England. And so it was, in 1854, that Herbert was able to write to Nightingale and ask her to go to Crimea. Florence Nightingale actually jumped at the chance. Put at the head of 38 volunteer nurses, the 37-year-old left behind her hospital for gentlewomen and got on a boat on October 21, 1854. It was supposed to be a dream come true, a chance to show her parents what she was really capable of. Instead, Florence Nightingale would soon find herself trapped at the center of a nightmare. On November 5, 1854, Florence Nightingale and her corps of nurses arrived at the British military hospital of Skutari, today a suburb of Istanbul. What they found there was something that would haunt them for the rest of their lives. The hospital was built atop a sewer which had flooded long ago and no one had bothered to plug it. When injured men walked into the toilets, they had to pass barefoot through a layer of ankle-deep feces. There were rodents running amok, men lying in filthy bedclothes that hadn't been changed for weeks on end. There was rotting meat lying around from where patients were supposed to cook their meals. There were people with unwashed, gangrenous wounds. This place was a human cesspit. A place where pestilence and disease roamed the hallways, draining death in their wake. The shock was so great that, for the first few days, it was all Florence Nightingale could do to keep functioning. The military brass made it clear that, after she landed, they didn't want her rocking their stinky, disease-ridden boat. So she tried not to. She really did. This became tricky, though, after November 10. On that day, the British wounded of two major battles arrived in Skutari. The hospital, already in dire need of supplies, effectively ran out. It was during this time, when she was surrounded by squalor and misery and the screams of the dying, that Nightingale famously called her new hospital the Kingdom of Hell. But the experience gave her the kick up the rear she needed to keep moving. Remember how we said that Florence Nightingale was super into math as a teenager? She started crunching the numbers for the hospital. To her amazement, she discovered that war injuries had killed around 4,000 people in the hospital that year. Sickness, on the other hand, had killed 19,000. This wasn't a hospital. This was a charnel house. Soldiers were coming in with treatable injuries, and they were leaving in coffins. Faced with an army determined to keep doing things the old way, Nightingale had no choice but to start trying to save those soldiers herself. This is the part where we get to the legendary image of Florence Nightingale. The nurse, walking the wards after dark, armed only with her lamp, offering succor to the dying. Certainly, this happened. Nightingale's nighttime visits became a fixture of the wounded men's lives. But really, this romanticized image is just a sideshow. The important stuff was happening behind closed doors. In meetings with army officers, Nightingale insisted on basic standards of cleanliness at Scutari, including regular bathing of patients and changing of bandages on wounds. At the same time, she campaigned for the open sewer flooding to the lower floors to be repaired, something we're having trouble believing she actually needed to campaign for at all. Of course, cleanliness and closing sewers doesn't make a good copy, so the newspapers that wrote about The Lady with the Lamp focused more on her bedside manner. These were the tales of Florence Nightingale, helping the wounded right at her home, of the nighttime visits she made to keep the men's spirits up. Incidentally, the reason Nightingale was the only one to visit the wards at night was because the other nurses were forbidden from doing so. Nightingale thought they would have sex with the male patients, so banned everyone else from roaming around after dark. It's just a random historical fact we couldn't fit anywhere else. Before long, the men of Scutari had grown to love their ministering angel, and the British public had grown to love her, too. That's right, Nightingale became a celebrity. The tales of her selfless good work were exactly the sort of tales Britain needed from a war that had produced no heroes. This reached its apex on February 24, 1855. That day, a London newspaper published an engraving of Nightingale with her lamp. Overnight, this random nurse working in a British military hospital became more than just a woman. She became a symbol. The days of Florence Nightingale the human were over, and the days of Florence Nightingale the lady with the lamp had arrived. Today, the truth of Florence Nightingale has almost been lost to the myths swirling around her name, both good and bad. For example, you've maybe heard of how Scutari actually had a higher death rate under Nightingale, whose reforms were more often than not fatal for patients. This is a tale that's cropped up before on places as venerable as the BBC, and is also likely complete bullcrap. Actual Nightingale scholars like Mark Bostridge are adamant that it's based on a misreading of the data. Sort of like how you might look at the way WWII combat deaths spiked after September 1939, and conclude Winston Churchill was the bad guy. Yeah. Deaths at Scutari jumped under Nightingale. But that's because she arrived just as supplies ran out and the hospital exceeded capacity. Now, that's not all to say that the lady with the lamp was always a saint. The same time Nightingale was at Scutari, around 1855, a British commission looking into sanitation proposed similar hospital reforms to hers. To this day, some think Nightingale essentially stole their ideas and passed them off as her own. Then there's the issue of Mary Seacole. A half-Jamaican doctoress who used herbal remedies, Seacole travelled to the Crimea under her own steam, and set up a hospital on the peninsula to treat sickened officers. She and Nightingale were aware of one another, and didn't like each other very much. There's some evidence Nightingale may have refused to let Seacole join her nursing corps due to her race. On the other hand, suggestions that Nightingale took credit for Seacole's innovations don't seem to have much ground in historical sources. Come 1855, though, Nightingale was a hero of the British Empire. Back in London, a fund had been set up in her name that would eventually raise £45,000, the equivalent to a really giant pile of money in today's pounds. The nurse had also won respect for getting her hands dirty. On a trip to Crimea itself, she'd been badly sickened and nearly died. While the papers celebrated her recovery, no one knew that she'd picked up brucellosis, a recurring infection that would soon leave her badly disabled. But that was all in the future. Until the war ended, all Florence Nightingale wanted to focus on was caring for her patients. On March 30, 1856, it finally did. The Treaty of Paris was the end of the Crimean War, a mass slaughter that had killed a million, but changed very little. Those millions that had died, by the way, almost all of them were carried off by disease. After the war ended, Nightingale stayed on in Scutari to help close the hospital before finally departing herself. On August 7, 1856, she arrived back in Britain to a hero's welcome. People treated her like the second coming of Elvis. And Nightingale hated it. As she saw it, the hysteria over the Lady with the Lamp was just a way of distracting from the real issues. And that was the reform that the army medical establishment desperately needed. In the end, she decided that she was just going to have to push through these reforms herself. In the mid-19th century, if you got sick, there was only one explanation. Miasma. Miasma theory is one of those things you sometimes hear about in history, and they sound so screwy, you almost can't believe people actually thought it was real. Basically, people thought that diseases were caused by bad smells. The cholera you might contract from raw sewage wasn't because of germs, but because of the smell of poo. Not long before the Crimean War, miasma theory had become so widely accepted that the British government actually approved a plan to drain sewage into drinking water, because that would be less harmful than letting it pong on the surface. By the time Florence Nightingale came along, miasma wasn't the only theory in town. Many medical professionals were sounding alarm bells that maybe this new germ theory was where it was at. But miasma was still the theory British politicians and army medical brass believed. But Florence Nightingale was about to explode all of that about as effectively as a stack of dynamite. After her return home, Nightingale devoted all of her energy and intellect to getting a Royal Commission established so she could look into preventable deaths in the Crimean War. But the army stonewalled her. So therefore, Nightingale teamed up with government statistician William Barr to provide evidence that something needed to be done. In 1856, statistical analysis was at the cutting edge of modern science. All those lovely, easy to understand charts you see on Nate Silver's blogs simply didn't exist yet. The fact that they do now is in part thanks to Nightingale and Barr. For roughly a year, the two worked to crunch the data by hand. They compared the records of the hospital at Scutari to a London military hospital, and then also to a Manchester civilian hospital as a control. The excellent podcast Bedside Rounds details this, and their episode on Florence Nightingale is a great resource for understanding her statistical breakthroughs. I'd recommend you check it out. Miasma theory suggested the hospital in Manchester should be the worst of all. Manchester in 1856 was a choking, billowing cauldron of stench. It was everything that miasma believers feared. But Nightingale and Barr's data showed something very different. The death rates in the Manchester civilian hospital were far below those in the London military one. While the death rate in Scutari had initially outpaced even the London hospital, after Nightingale's reforms it had dropped into second place. A military hospital in the civilized British capital had a higher death rate than a field hospital on the edges of an active war zone. As Nightingale put it, sanitation in British army hospitals was so bad, it was akin to taking 1,100 young men out onto Salisbury Plain each year and shooting them dead. When Nightingale and Barr presented their findings, they did so visually, using what we'd now call a coxcomb graph. It's said that this was likely one of the first times in history data was ever presented visually. That made it easier to understand. When the government saw her graphs, Nightingale was vindicated. A major review of army medical standards, it was undertaken with sweeping effect. The reforms the Lady with the Lamp had first started all the way back in Scutari were implemented across the board, including methods for cataloging disease and death rates that were still in use well into the 20th century. By the time the British Army intervened in China's bloody Taiping Rebellion in the early 1860s, Florence Nightingale's recommendations had so taken root that the death rate for soldiers from disease was 90% lower than it had been in the Crimean War. For Nightingale, this was a major triumph. The last half-decade of her life had been consumed with forcing army medical culture to change. And now, here she was, directing those changes. But there would be no time for celebration. In 1857, Nightingale suffered her first collapse due to the Brasiliosis infection she had picked up in Crimea. In no time at all, the disease had emaciated her. She lost all her hair. She lost weight. She became effectively bedridden, often suffering pain so acute that she was unable to work. For the rest of her life, Britain's most famous nurse would live in agony. From a physical standpoint, that was pretty much it for Nightingale. After coming down with her illness, she retreated to bed and never really left. But while she'd never again go as far away as Crimea, the polymath nurse wasn't done yet. In fact, she was just getting started. Confined to her bed, Nightingale started writing letters, hundreds of them, thousands of them, campaigning letters going out to all corners of the country, outlining the need for major medical reforms. And that's not all she did. Remember how people in Britain raised £45,000 for her while she was in Scutari? Well, Nightingale took that money and used it to fund a secular nursing school, St Thomas's Hospital, in London. The Nightingale School wasn't the first nursing school in Britain, but it was the first that fulfilled three strict criteria. 1. It was secular. 2. It developed its program in line with scientific advances. And 3. It treated nursing as a career. No longer would nursing be something for nuns and the lower classes. Nightingale wanted to make nursing a legitimate profession. You can see she succeeded just by looking around you today. Nowadays, those who see nursing as synonymous with prostitution are strictly stupid, horny men with a tragic thing for uniforms. But this is where it all started. Nightingale School was the first to give nurses good pay, sick leave, and annual vacation. Perhaps most importantly, though, the school encouraged nurses to travel, to set up schools in other countries, and to pass the message on. Within a few years, Nightingale nurses had fanned out across the British Isles. A few years after that, they were establishing schools in America. A few years after that, they were even setting up hospitals in Japan. As they went, the Nightingale nurses took some core tenets with them. Nurses should be separate doctors, rather than merely subordinate. They should enforce cleanliness and the washing of wounds. And healthcare should be available for everyone. If you live in a nation with universal healthcare, it may well be in part thanks to Florence Nightingale. From her bed, the great medical reformer tirelessly advocated for equal treatment of the poor by nurses and doctors. It's this belief that eventually evolved into Britain's modern NHS. Of course, there was more to Nightingale's last years than just medicine. She became the first female fellow of the Royal Statistical Society. She advocated for minority rights across the British Empire. She also wrote one of the key texts of 19th century feminism, Cassandra, a book detailing how intelligent women are often ignored by less intelligent men, which unfortunately still seems pretty relevant. But perhaps the most interesting thing about Florence Nightingale's later life is how private it was. Famously prickly, the now elderly Lady with the Lamb hated receiving visitors. She hated having her picture taken. She hated being reminded of her fame. Towards the end of her life, she declared, I only want to be forgotten. And she changed her will to stipulate that she should not have a public funeral. Finally, on August 13, 1910, she breathed her last. For the British public, it was like a symbol of the nation had been lost. Despite her pleas for a private funeral, people lined the road all the way to Nightingale's final resting place. Government ministers made speeches at a special service at St. Paul's Cathedral. Although Nightingale had specified that she wanted to be buried in an anonymous, unmarked grave, she was finally put to rest beneath a headstone bearing her name at St. Margaret's Church. Today, the legend of Florence Nightingale is still going strong. She's endured as a symbol in a way that few ever will. Every year, nurses still carry lighted lamps into Westminster Abbey in London to mark the passing of the Lady with the Lamp. It's a touching ritual. It's poignant. It's also something Miss Nightingale probably would have hated. Florence Nightingale didn't want to be remembered. She didn't want to have lamplight processions and YouTube videos about her life. She simply wanted to vanish. To be anonymous. But sometimes, someone lives a life so great that forgetting them simply isn't an option. When Florence Nightingale was born, women were considered incapable of understanding concepts like statistics. Nursing was considered unsuitable for middle class girls. Being healthy meant not sniffing smelly air. The fact that Florence Nightingale was able to not just challenge all of these assumptions, but help overturn them, explains why she's remembered today. Born into a world with a glass ceiling so low it's practically a cage, Nightingale managed to smash through it. And in doing so, she changed the world. She may have been a living legend who wished to be forgotten, but she was also something else. A symbol for both the wounded and the dying. And those who wished to tend for them. She was, if nothing else, the Lady with the Lamp.