The Lady with the Lamp
Florence Nightingale was the founder of modern nursing and hospital
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.
Her parents were William Edward Nightingale, born William Edward
Shore (1794-1874) and Frances (“Fanny”) Nightingale nee Smith
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.
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.
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 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.
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.
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
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.
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'.
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
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
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
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.