Florence Nightingale:

The Lady with the Lamp

by Mallika de Silva

Florence Nightingale was the founder of modern nursing and hospital epidemiology

The era of modern nursing commences with the work of Florence Nightingale in the Crimean War (1854-1856). She was born on May 12, 1820. She belonged to a rich, upper class, well connected British family at the Villa Colombia, near the Porta Romana at Belloguardo in Florence, Italy, and was named after the city of her birth.

Florence Nightingale

Her parents were William Edward Nightingale, born William Edward Shore (1794-1874) and Frances (“Fanny”) Nightingale nee Smith (1789-1880).

Inspired by what she took as a call from God in February 1837 while at Embley Park, Florence announced her decision to enter nursing much against the wishes of her parents. In 1844 despite the intense anger and distress of her parents, she rebelled against the expected role for a woman of her status to become a wife and mother.

Education

Nightingale worked hard to educate herself in the art and science of nursing, in spite of opposition from her family and the restrictive social code for affluent young English women. Nightingale was a courted by politician and poet Richard Monckton Milnes, first Baron Houghton, but she rejected him convinced that marriage would interfere with her ability to follow her calling to nursing.

She studied nursing in hospitals, visited many countries in Europe to gain first hand information about nurses training. Prominent among the institution she visited the Sisters of Charity in Paris and Kaiserswerth in Germany. Besides, she visited many hospitals, infirmaries and religious houses. As a result of these studies, Nightingale was fully convinced of the need for an organised training program for nurses. On August 22, 1853, Nightingale took the post of Superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London a position she held until October 1854.

Crimean War

Then Crimean War (1854-1856) broke out in which England was participating along with France and Turkey against Russia. The news came that the condition of the sick and suffering soldiers were deplorable and that many were dying in hospitals for want of proper care.

Florence Nightingale's contribution came during the Crimean War, which became her central focus when report got back to Britain about the horrific conditions for the wounded. Newspaper reports of unsatisfactory conditions at the military hospital had aroused the public, and secretary of war responded by appointing a team of nureses to address the situation.

The Secretary was a friend of Nightingale and knew her leadership skills. Florence Nightingale who was 34-year-old at that time offered her services to the British Government which were readily accepted. Florence Nightingale first gained fame by leading a team of 38 nurses to staff an overseas hospital of the British Army during the Crimean War. She together with the 38 nurses set off for Constantinople. They arrived at Scutari on November 4, 1854 just after the battle of Baladawa and went straight to the Barvack Hospital there. Her team found the poor care for wounded soldiers indeed deplorable with crowded hospitals, filthy wards and unattended patients. Patients were covered with rags soiled with dried blood and excreta.

Poor conditions

The water supply was contaminated and the food inedible. Sewerage discharged on to floors of wards and dead animal rotted in the courtyards. According to Nightingale, the hospital case fatality rate during the first months after her arrival was 42 percent.

Although Nightingale did not accept the concept of bacterial infection, she deplored crowding and unsatisfactory conditions. She took up her duties at once and brought cleanliness and order in the hospital wards. She and her team of nurses attended to the sick and wounded with great devotion. She put her nurses to work sanitising the wards and bathing and clothing patients.

Nightingale addressed the more basic problems of providing decent food and water, ventilating the wards and curbing rampant corruption that was decimating medical supplies.

Hostile bureaucracy

She had to overcome an inept and hostile military bureaucracy, which she did not part by paying for medication from private sources, including her own funds. She also kept careful statistics. Within six months the number of hospital fatality had dropped from 42 percent to 2 percent either by making improvements in hygiene herself or by calling for the Sanitary Commission.

However, the death rate actually began to rise to the highest of all hospitals in the region. During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds.

With overcrowding, defective sewers and lack of ventilation, the Sanitary Commission had to be sent out by the British Government to Scutari in March 1855, almost six months after Florence Nightingale and arrived.

The commission flushed out the sewers and improved ventilation. The death rates were sharply reduced, but she did not recognise hygiene as the predominant cause of death at the time and never claimed any credit for her work.

Death rates

Nightingale still believed that the death rates were due to poor nutrition, lack of supplies and overworking of the soldiers. After she returned to Britain and began collecting evidence before the Royal Commission on the health of the Army, she came to believe that most of the soldiers at the hospital were killed by poor living conditions. The experience influenced her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced peace time deaths in the army and turned attention to the sanitary design of hospitals.

During the Crimean War, Florence Nightingale gained the nickname “The Lady with the Lamp” from phrase in a report in ‘The Times'.

Ministering angel

She is a ministering angel with out any exaggeration in these hospitals, and as her slender form glides quietly along each corridor every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.

In Crimea on November 29, 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognise Nightingale for her work in the war.

There was an outpouring of generous donations. Nightingale had $ 45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas’ Hospital on July 9, 1860. The first trained Nightingale nurses began on May 16, 1865 at the Liverpool Workhouse infirmary.

Now called the Florence Nightingale School of Nursing and Midwifery, the school is part of King's College, London.

The Nightingale nurses took up positions as teachers, matrons and administrators not only in England, but also in America, Europe and British Colonies.

They became pioneers in nursing education and administration from 1860 onwards, the Nightingale system of training nurses spread to all parts of the world.

The Nightingale Pledge taken by new nurses was named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday May 12.

The writer is a former Principal of the School of Nursing under the Department of Health.