Friday, May 12, 2017

The Lady of the Lamp—Florence Nightingale

Florence Nightingale--The Lady of the Lamp of the Crimean War.

Britain and America each have iconic nurse heroines.  But other than sharing a common calling, horrific experience in war, and a steely determination, Florence Nightingale and Clara Barton could not have been more different.
Nightingale was the daughter of a wealthy landowner and member of the British ruling class.  Barton came from a struggling but respectable family of middling means.  Nightingale struggled to gain acceptance for nursing as a respectable occupation for gentle women.  Spinster Barton had no choice but to work spending years as a school mistress before volunteering without training to serve the Civil War wounded.  Nightingale came from a family with Unitarian connections but was a devoted Anglican.  Barton was raised a Universalist who had no religious affiliation in later life, but credited her ethics to her childhood faith. Nightingale was interested in the professionalization of nursing, sanitation practices, and what we would now describe as holistic medicine.  Barton cared about the amelioration of suffering and building a new model of active charity and volunteerism.  Disabled by illness and perhaps Post-Traumatic Stress Disorder, Nightingale had to largely retire from active nursing and administration within a few years of returning from the Crimean War and spent the rest of her long life as a semi-invalid, writer, and researcher.  Nightingale never embraced feminism, was in fact openly critical of it and cultivated the support and friendship of powerful men.  Barton, although necessarily careful to curry support for the American Red Cross from the President and Congress, was supportive of women’s suffrage.

Clara Barton, America's Angel of the Battlfield was inspired by Nightingale but very different from her.

But, of course, Nightingale’s famous example inspired and motivated Barton in her own career.
Florence Nightingale was named for the city of Florence, then the capital of the Duchy of Tuscany on May 12, 1820.  Her father, born William Shore, inherited a rich country estate from his mother’s family and assumed their name, Nightingale. 
In 1825 the family returned to England where they took up residence in a large and elegant new country home on the familial estate, Lea Hall in Derbyshire.  The following year her father bought a second estate, Embley Park, in Hampshire.  Soon after he was appointed the High Sheriff of Hampshire.  The family divided their years between the two country seats.
Nightingale was home tutored, like most of her class, but benefited from parents who allowed her to study deeply beyond the narrow instruction usual for women of her class and place.  By here late teens she was as academically accomplished as most university educated men.
Her mother, despite progressive social views and ardent abolitionism, was a Victorian traditionalist when it came to the role of women.  She ardently opposed young Florence’s announcement that she was determined to find a career in service, and particularly in nursing.  Women nurses were not unheard of.  But other than Catholic and Anglican nursing orders, it was considered an unskilled job for the lowest orders of society.  Because they were required to come into close physical contact with patients, including men, it was assumed that they were degraded and likely to service their charges sexually as well.  In fact, secular nurses were often regarded as little more than prostitutes.
Despite her mother’s opposition, in 1844 Nightingale launched a round of visiting hospitals in London and elsewhere, observing conditions and techniques, and eventually volunteering her services.  She rejected an ardent suitor, politician and poet Richard Monckton Milnes, for fear that marriage would interfere with her calling.  She continued her hospital visits for 14 years, eventually attracting the attention and support of others.

Florence Nightingale as a teen age beauty about the time she renounced romance and declared her determination to pursue nursing.
In 1849 Nightingale undertook extensive travels in Europe, Turkey, and Egypt.  He mother probably hoped the Grand Tour would divert her from her purpose.  She was dead wrong.  She used the trip to make visits to hospitals and study nursing techniques.  She spent time with in Egypt she visited a convent of nursing sisters of St. Vincent de Paul in Alexandria, where she was impressed by the order and discipline that made their care superior to anything she had found in Europe
Later on the journey she spent considerable time at the Institute of Protestant Deaconesses at Kaiserswerth in Germany. The institute had been founded for the care of the destitute in 1833 and had grown into a training school for women teachers and nurses.  She described the event as the turning point of her life.  She returned to the Institute in 1851 for four months of medical training—the only formal nursing education she ever received.  She vowed to establish similar training programs in England.  Her accounts of her experiences there, The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc, was her first major publication and drew attention for her plans in England. 
Nightingale’s sister also published her extensive correspondence describing in detail her experience in Egypt and “The Orient” which showed her as a gifted travel writer and astute observer of life and customs in other lands.
During these travels Nightingale also made contact with important British political figures also traveling abroad, especially Sidney Herbert, who she met in Rome.  Herbert was a former Secretary at War in the Tory government Sir Robert Peel and would be called back to that post during the Crimean War.  He became a lifelong devoted friend and supporter of Nightingale. 
Back home, Nightingale resumed her round of hospital visits will arguing for opening nursing to respectable women and for formal schooling for them. 
In 1852 she finally got a position where she could put her ideas into practice as the Superintendent of the Institute for the Care of Sick Gentlewomen in London.  It may not have been tending to the poor as she one day hoped to do, but it was a start.  In her relatively short tenure at the Institute, she inaugurated formal training for her nurses.
About the same time, probably against his wife’s wishes but bowing to the inevitable, Florence’s father settled an £500 annual income on her allowing her to live comfortably while pursuing her career.
What interrupted Nightingale’s new job was the onset of the Crimean War, as foolish a major power conflict as was ever fought.  France under the newly minted Emperor Napoleon III, Britain and Russia chest bumped over the rotting but still alive corpse of the Ottoman Empire.  The immediate cause of the war, Russia’s occupation of Ottoman provinces along the Danube ostensibly in defense of Orthodox rights, was voided when Austria threatened to join the coalition against the Tsar and Russia withdrew its troops.  Undeterred, the war went on anyway, fought mostly in naval actions on the Black Sea beginning in 1853 and on the Crimean Peninsula with the siege of the port of Sevastopol in September of 1854.  Large, stupidly led Ottoman, French, and British Armies slogged it out against stubborn Russian resistance, cholera, and other epidemics.
Considered the first modern war because of the use of steam powered war ships, iron clad floating batteries, railroads, telegraph lines, massed artillery, the war quickly turned into a charnel house.  And for the first time reporters traveling with the armies got word back to London and Paris by wire within hours of actual events.  Newspapers quickly filled with grim stories.
Word also got back to England about the suffering of the British wounded in comparison to the French, who had better organized medical services and hospitals.  Nightingale offered her services and her friend Herbert, back as Secretary at War, quickly accepted the offer and promised her full support and all of the supplies she needed.
Nightingale set sail for the war zone on October 21, 1854 in charge of a hastily recruited force of nurses including 10 Roman Catholic nuns, 8 Anglican Sisters of Mercy, 6 nurses from St. John’s Institute, and 14 from various other hospitals.  
Nightingale rejected the services of Jamaican traditional healer/doctor Mary Seacole who made it to the Crimea on her own and served much closer to the front lines than Florence.  After brief recognition the memory of her service was nearly erased by Nightngale's fame.
She declined the services of Mary Seacole a Black Jamaican traditional doctor.  Seacole traveled to the Crimea anyway at her own expense and served valiantly near the front lines.  Briefly honored upon her return to England, her memory was virtually erased as Nightingale’s reputation soared.
Florence’s group arrived early in November 1854 at Selimiye Barracks in Scutari, Istanbul, 250 miles across the Black Sea from the Crimea.  Thousands of British wounded were warehoused there with almost no support.  This would be Nightingales main base throughout the war.
She found appalling conditions:
There were no vessels for water or utensils of any kind; no soap, towels, or clothes, no hospital clothes; the men lying in their uniforms, stiff with gore and covered with filth to a degree and of a kind no one could write about; their persons covered with vermin . . .
We have not seen a drop of milk, and the bread is extremely sour. The butter is most filthy; it is Irish butter in a state of decomposition; and the meat is more like moist leather than food. Potatoes we are waiting for, until they arrive from France . . 
Contemporary illustrations in the British Press could not begin to capture the horror and suffering amid the primitive conditions at Nightingale's hospital at Scutari.
Nightingale appealed through correspondent William Russell of the The Times for supplies and assistance.  The Times organized relief drives and supplies began to trickle in by year’s end. 
Despite improvements and the best efforts of her overworked nurses, death rates actually climbed in the hospital in the months after Nightingales arrival due to sanitary conditions and overcrowding.  Cholera, typhus, and typhoid swept the wards.  Over 4,000 men died there over the winter.
Meanwhile the government commissioned a prefabricated hospital and dispatched it to the scene under the civilian leadership of Dr. Edmund Alexander Parkes.  When it arrived and was set up nearby, its death rates were less than 1/10th of those at Suctari under Nightingale’s care. 
In March of 1865 a Sanitary Commission arrived from home which flushed the sewers at Suctari, after which deaths dropped sharply.  Nightingale did not recognize the connection however, and credited the improvement to nutrition and nursing care. 
Despite their limitations, Florence and her nurses worked tirelessly, none more so than their leader.  In addition to her administrative duties, she spent much time in the wards.  And because the prejudice against nurses persisted among Army authorities, only Nightingale was allowed on the wards at night to aid the ill trained and sometimes brutal male orderlies.  She visited bedsides carrying a lantern, earning her the nickname Lady of the Lamp among her charges.
Russell spread the word of her service back home where she was hailed as a hero.  The Nightingale Fund for the training of nurses was set up under the stewardship Herbert while she was still abroad and an astonishing £ 45,000 was raised by 1859.
In May of 1855 Nightingale finally made it to the Crimea, inspecting hospitals near the front at Balaclava.  While there, she fell ill with “Crimea Fever” and lay dangerously near death for 12 days.  She returned to Suctari weakened.  But she resumed her duties and even returned Balaclava in March of 1856, remaining there until after active fighting ceased on the peninsula when the hospitals there were closed in July.

Florence Nightingale after her return from the war.  After the Queen herself she was the most famous and admired woman in Britain.
In August Nightingale boarded a French ship and returned privately to England where she was hailed as a great heroine.  She was introduced to Queen Victoria herself and presented the monarch with a report on conditions.  Her fame even crossed the Atlantic where Henry Wadsworth Longfellow memorialized her in Santa Filomena
Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
In 1860 with money from the Nightingale Fund the Nightingale Training School at St. Thomas' Hospital opened in London.  Nurses there were trained in a course of study designed by Florence.  She was, however, too ill to accept the superintendency of the new school.  She also raised money for the Royal Buckinghamshire Hospital   near her family home.  But her days as an active nurse and administer were over.
Nightingale busied herself with a close study of statistics from the various hospitals and medical facilities in the war.  What she discovered caused her to dramatically re-assess her own views.  In 1859 she published her findings in Notes on Matters affecting the Health, Efficiency and Hospital Administration of the British Army in which she acknowledged the supreme importance of sanitation in reducing hospital deaths.  In 1859 an army medical college was opened at Chatham and the first military hospital was established in Woolwich in 1861 following the advice laid out by Nightingale.
That was followed in 1860 with Notes on Nursing which laid down the educational program adopted at the St. Thomas school and others throughout Britain. 
When the Sepoy Rebellion broke out in India in 1857, Nightingale volunteered once more to go abroad.  But her health would not permit it.  Instead she undertook a deep study of India and wrote many articles about the sub-continent over the next several years, including a detailed proposal for digging wells in Indian villages.

Florence Nightingale, semi-invalid, in her later years.  Photo by Milburn.
Nightingale continued to write and was honored time and again over the next decades.  She participated as far as she was able in events like the Queen’s Diamond Jubilee. 
Nightingale died in London, on August 13 1910 at the age of ninety and was buried in the family plot at East Wellow, Hampshire after an offer of burial in Westminster Abbey was turned down by her family. Memorial services took place in St. Paul’s Cathedral.  

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