Schoolzone: Florence Nightingale – the life and times of the first advocate for good hygiene

01 August 2011

Serving the poor, sick and wounded, campaigning for – and accomplishing – healthcare reform, and developing new statistical graphics; just a few of the achievements of one of the most remarkable and influential women of Victorian Britain. August 13 marks the 100th anniversary of the death of Florence Nightingale. The ‘Lady with the Lamp’ dedicated her life to the care of others.

Florence grew up in a wealthy household during a period of immense social change – surrounded by liberal and reforming ideas, she was interested in the affairs of the day. Florence and her sister, Parthenope, were educated by their father. His curriculum included Latin, Greek, history, philosophy, mathematics, modern languages and music. The education they were given was in line with that more often accorded to sons. However, due to her social standing and sex, the opportunities for Florence to use her education were limited. 

Throughout her life, Florence had a strong Christian faith; at the age of 17 she believed that God was calling her. She felt that her vocation, and her calling, was to become a nurse. Initially, she was dissuaded by her parents from entering the nursing profession; at this time, only old women were nurses and it was not an appropriate career for a woman of her intelligence, looks, status and social standing. Against her parents’ wishes, at the age of 30, Florence travelled to Kaiserswerth, near Düsseldorf in Germany, to complete her nursing training. Following this, she spent 3 years visiting hospitals in the UK and Europe in her study of public health. It was not until 1853 that she took up her first employment, which her mother had secured for her, in a private institution for sick gentlewomen at No. 1 Upper Harley Street, London.

The Crimean War began in 1853 and, by the autumn of 1854, the conditions in military hospitals were horrific – soldiers were dying in agony and there was public outcry. Sidney Herbert, the Minister for War, whom Florence had met in 1847, invited her to lead a group of female nurses to the army hospital in Scutari, Turkey. This was an unprecedented idea; no woman had previously held an official position in the army and it became the focus of great publicity. On arrival, the conditions in Scutari were  much worse than expected; more soldiers were dying from disease and from the cold conditions, than were dying in battle. Florence worked tirelessly to improve hospital management, the quality of the sanitation and nutrition and to increase much needed supplies. Her programme of work dramatically reduced the death rate of patients within the hospital. Her nickname ‘Lady with the Lamp’ came from her night rounds of the hospital, which covered 4 miles of hospital corridors, with her Turkish lamp.

In order to avoid publicity, an exhausted Florence returned to Britain under the pseudonym of ‘Miss Smith’. She was in poor health, but continued to lobby those in power, including Queen Victoria, for healthcare reform and to investigate mistakes made during the war. During these investigations, she discovered that there were 16,000 deaths as a result of disease and, by contrast, only 4,000 from battle injuries. Working with statistician Dr William Farr, she created iconic diagrams, now known as polar area diagrams, to illustrate her findings. These were some of the first pie charts.

The germ theory of disease, which states that microbes are the cause of many diseases, was not established until 1867 and, like many of her contemporaries, Florence believed that ‘miasma’ (foul air) caused disease. Elimination of these miasmas led to improved hygiene and sanitation and thus removal of pathogens. Although the science was inaccurate, the intervention was successful. Florence ultimately accepted the germ theory of disease, though stressed a need for prevention rather than cure, and continued to advocate good hygiene and sanitation practices. She also believed that poor hospital design would undermine even the best nursing practices.

Florence contracted brucellosis, also known as Crimean Fever, during the war. She continued to suffer from the disease for the rest of her life and was frequently bed-ridden. It is likely that she contracted the disease from goat’s milk or cheese infected with the bacterium Brucella. Her symptoms included fever, insomnia, loss of appetite, back pain and exhaustion, and she often appeared close to death.

Life expectancy for a baby born in 1820 was 35; however, Florence lived a long and productive life, dying at the grand old age of 90. Her legacy remains today due to the changes in attitudes towards the nursing profession and the reform of the healthcare system.

Vicki Symington, Education & Outreach