THE BEADING GEM'S JOURNAL

Posted: 11 Nov 2012 05:00 AM PST

It seems particularly fitting to feature Florence Nightingale (1820-1910) on Remembrance Day. She was the woman who pioneered modern nursing methods and brought about dramatic improvements to military and subsequently, civilian hospitals. She established nursing as a profession.

Less known is her uncommon talent as a statistician, an important skill which helped her in her lifelong quest, one she believed God sent her on. She dedicated herself to this cause despite strong family opposition. She never married.

Florence came from a wealthy and extremely well-connected Victorian family. She was the younger of 2 daughters of William and Fanny Nightingale. Both Parthenope (Greek name for Naples) and Florence were named after their birthplaces - their parents were on an extended honeymoon tour of Italy at the time.

Her family were Unitarians. These liberal Christians believe in reason, rational thought and progress, accepting the co-existence of religion and science. Many of her relations held progressive views for the time - her maternal grandfather was the abolitionist, William Smith and some of her aunts had feminist leanings.

Florence did not go to the Crimea to attend to injured British soldiers until she was in her thirties. Yet, her early life and unusual upbringing made her the woman she was to become and in many ways prepared her for the tribulations she was to face.

Her interest in medicine and empathy for those who were sick and need of care began in childhood. She displayed an incredible thirst for knowledge and developed a compulsive habit of noting everything down from a very young age. One of the earliest documents in her handwriting is a tiny book. Florence, at age 7, had carefully recorded the correct dosages of James compound, a common medication in her time, noting "16 grains for an old woman, 11 for a young woman and 7 for a child."

Her adoring older sister once wrote about the time when Florence came down with whooping cough - all 13 of her dolls apparently had tiny red flannel scarves around their necks too! When she was 12, she took over the care of her little baby cousin when his nurse fell ill while his mother and her mother was away. At 17, a flu epidemic laid low everyone in the household except for her, the cook and a cousin so she cared for the sick.

Florence thus became the one the extended family turned to if anyone needed help with nursing. She also began to take care of sick villagers near her homes she knew regardless of their station in life. They adored her. Her keen awareness of their needs and her own growing knowledge of practical nursing care were all key to her success then and much later on during the war.

Florence and Parthenope were home schooled when very young. It was a miserable time for the precocious Florence because her natural curiousity and energy were suppressed by the well meaning but uninspired governess. Florence became noticeably introverted. Fortunately, the governess left to get married when Florence was 10.

Most unusually for a Victorian father, William then started teaching his daughters himself. He was a rare man of his day - most believed women need not be educated - but not he. An intellectual, William taught them languages, arts, science and mathematics. He cultivated their intellect and the girls thrived under his tutelage, particularly Florence who was exceptionally bright. The girls may have been denied entrance to universities at the time by virtue of their gender but he made up for this lack with his tutoring. The greatest gift her father ever gave Florence was her intellectual self-confidence.

Her mother passed to Florence her talent for organization. Fanny efficiently ran their large family homes - Lea Hurst and Embley Park. Fanny was socially ambitious and naturally she wanted the best chance in life for her two girls. She was overly protective, a conventional Victorian mother in every way. She never really understood her younger daughter's intellectual needs.

Embley Park, now a school

When the 20-year-old Florence expressed a desire to continue with her mathematics lessons, Fanny flatly refused. Heaven forbid that a young unmarried woman would be taught by a male tutor! Florence though did manage to squeeze in a few precious weeks of private math tutoring at one uncle's house when she was there helping an aunt during the last stages of her pregnancy.

Florence was a charming, amusing and captivating individual who attracted many admirers, both men and women, all her life. So given Fanny's efforts to place her girls in the right social sphere to make advantageous marriages, imagine her mother's frustration when Florence turned down marriage proposals over the years.

Deep down she felt she had much more she could do with her life than accept what she saw as staid and bland marital lives in a straitlaced society. She could never understand why her father was content to stay idle when he could, as a man, do so much more with his privileged life. The quiet and inconsequential lives of upper class women of her time trapped in their gilded cages as it were, definitely did not appeal. In short, she craved "a profession, a trade, a necessary occupation, something to fill and employ all my faculties."

Florence tried to find the way to learn how to nurse through her twenties and thirties. This ambition horrified her parents and her sister who couldn't bear to be apart from Florence. Her mother initially fainted initially and then rued, "We are ducks who have hatched a wild swan." Florence was bitterly disappointed her family did not support her during this time and she become depressed. She wrote, "In my thirty first year, I see nothing desirable but death."

But it was because they loved her very much that they feared for her health and welfare, which as it turned out later, was justified. They could not understand why a lady of Florence's rank would risk her health to care for poor sick people. Rich people in those days employed private carers but the vast majority of the population had to rely on public hospitals which were terrible places to be in.

Most "nurses" then were poverty stricken women hired to watch patients and keep them clean. They were often drunk and sometimes known to have sexual relations with doctors, male dressers (of wounds) and even patients. Fanny actually thought at one point Florence might have had an illicit liasion with some "low vulgar surgeon" to account for her daughter's desire to work in such hospitals.

Over the years, she did manage to visit different hospitals in Europe but there really wasn't anywhere she could truly learn from - there was plenty of devoted care but good hygiene was decidedly absent. Just before she went to the Crimea, she was put in charge of the Institution for Ill Gentlewomen in Distressed Circumstances (i.e. destitute governesses), a charitable hospital.

She was able to take up the post because her father finally gave her an income and thus her independence. She turned a rat infested building into a clean and efficiently run place with top medical care. She also helped local hospitals manage the huge influx of patients when cholera broke out. Eventually, even her mother and sister rallied by her side and began to help.

Florence Nightingale in her 30's

Her work did not go unnoticed by the many influential friends in her circle. These included Lord Shaftesbury, the great reformer and Sidney Herbert, the Secretary of War during the Crimean War who was instrumental in sending her and her small team of handpicked nurses to the theater of war.

Lord Shaftesbury (7th Earl) and Sidney Herbert

The Crimean war (1853-1856) was fought by Britain, France and Turkey against Russia which had threatened Turkey. The British army was incredibly ill prepared for the war. Poorly led and badly supplied, they were totally negligent in the provision of medical care. The whole campaign soon became an unmitigated disaster.

Map of Crimea with battle sites marked (Source)

Scathing reports by the world's first war correspondents outlined a grim picture of inadequate care, overworked medical staff, insufficient food and non-existent hygiene at the army hospitals. 10 times more men died of diseases such as cholera and typhus than from battle wounds. Men covered in lice, in their own waste and blood soaked bandages days old were taken and dumped into these places which didn't have any linen, cots or even cutlery. Dying men were simply abandoned to suffer alone in horrific circumstances.

Injured arriving at Balaklava

It took 4 days of waiting after their arrival in Scutari before the doctors agreed to let Florence and her 38 nurses help and only because they were suddenly overwhelmed with hundreds of incoming wounded men. Within weeks, the women brought order to the misery and chaos to the gratitude of all the common soldiers. Florence insisted those who needed care most would get it irrespective of rank. This practice of triage went against the class expectations of the time. No wonder ordinary soldiers came to idolize her.

Florence worked long hours - she was sometimes on her feet for 20 hours at a time. Taking care of long hair was next to impossible so she had it cut short! Although she personally nursed some patients - usually the most critically ill ones in the fever and dysentery wards - much of her time was actually spent in organizing, motivating reluctant orderlies and dealing with army doctors and purveyors who did not care for her "interference". She did everything calmly, efficiently and by example even though she was seething inside against the ineptitude and inaction.

One of the wards at Scutari Hospital where Florence worked

She took some matters into her own hands such as setting up a private kitchen which produced hot soup and other invalid food. No cutlery, food containers and other essentials? She bought those from her own private and government funds she was in charge of. She organized laundry crews and the making of linen. Florence was a truly remarkable administrator.

The legend of the Lady with the Lamp came about because she would make her solitary 4 mile rounds carrying a little Turkish lamp, checking on the patients late each night. It might have begun as an inspection round but it became a comforting ritual for the men. One man wrote home, "What a comfort it was to see her pass even. She would speak to one, and nod and smile to as many more; but she could not do it all you know. We lay there by hundreds; but we could kiss her shadow as it fell and lay our heads on the pillow again content."

From Illustrated London News (1855)

Florence was a superb nurse in her own right. It was not just about medical nursing. She talked to the patients and helped them in many ways. She wrote hundreds of letters home for the illiterate and the dying. She included their personal effects in small parcels, even paying for the postage out of her own pocket. She understood how important it was for a nurse to administer the final solace for those who would not survive.

She never raised her voice in the hospital but her letters to Sidney Herbert, her staunch ally, burned with anger as she reported to him the real situation, not the whitewashed one appraised by the British Army for the government back home.

The death rates started to drop with her team's efforts but it wasn't until the Sanitary Commission suggested by Lord Shaftesbury came, did they really fall rapidly. The team cleared sewers, removed animal carcasses from water supplies and improved ventilation some 6 months after the nurses arrived.

Florence was well ahead of her time. She and her team kept immaculate records but she also wanted the army doctors to start maintaining medical statistics on a regular basis. She even floated the idea of establishing a medical school there so that the army doctors would learn to deal with battle wounds and diseases.

One of her suggestions included proper operating rooms for the future. There were actually none while she was in the Crimea. Doctors performed amputations right on the hospital beds. All the nurses could do was to put up curtains so the other men were spared the sight.

The faces of those she watched die haunted her after the war. This woman who never had any children of her own, nevertheless considered herself a mother to thousands of soldiers. She wrote to a friend, "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 graves, 73 percent in eight regiments during six months from disease alone."

Much of her pioneering work was actually done after the war. Analyzing her data made her realize the importance of good sanitation. She subsequently put that knowledge to good use. In order to win over her arguments for army and civilian hospital reforms, she presented her data as graphs. The visual form had greater impact than long columns of numbers. She used a type of pie chart, a circular histogram which she called it a coxcomb. It was a novel approach as pie charts were fairly new then and not widely known.

The blue areas showed the mortality figures for disease which were far more extensive than the red areas which represented the men who died from battle wounds. You can see a dramatic animation of her coxcombs from Uncertainty.org. Click on the arrow in the diagram to begin the animation.

Florence continued to suffer terribly for more than 20 years from an acute form of brucellosis (also sometimes known as Crimean fever) she picked up during the war. She most likely caught the bacterial infection from drinking contaminated milk. It sometimes caused excruciating pain to her joints and back, made her breathless, fatigued and she often felt "like the top of my head was blown off."

Florence Nightingale Charm/Pendant by Cats Brass on Etsy

Florence was often bedridden but the workaholic Florence still continued to campaign for hospital reform. Constantly writing, she churned out papers, books and a huge mountain of correspondence. She was so ill from 1861-1868, she had to be carried from room to room. She even discouraged her immediate family from visiting so she could concentrate her limited time and energy on her cause. Key supporters who visited were able to help her achieve her goals.

Her legacy was the establishment of modern professional nursing. She was instrumental in the creation of the first nursing school, now called the Florence Nightingale School of Nursing and Midwifery. An outpouring of public donations helped fund the school. Nurses today still take the Nightingale pledge, named in her honor.

She also became the first woman to a Fellow of the Royal Statistical Society, a remarkable feat at a time when women were barred from learned societies. Florence believed, "statistics were a measure of God's purpose."

Lady with the Lamp Earrings by Cats Brass

On a personal level though, she did not welcome the public's adoration of her. However, she did agree to sit for a sculptor only because it was a commission from the British army. Non-commissioned officers and ordinary soldiers had raised money for it. The sculptor, Sir John Steell, said that many of the soldiers, widows, orphans and sweethearts who came to his studio to see the bust did so with tears of gratitude.

She mellowed considerably in her last two decades, living quietly with her beloved cats. She died peacefully in her sleep in her ninetieth year. A few survivors from that distant war came forward to carry her coffin having never forgotten her selfless care.

Lest We Forget.

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