Notes on her life and a visit to her museum in London

1. Florence Nightingale: she followed her dream and her high standards ultimately revolutionized the nursing profession Notes on her life and a visit to her museum in London

2. Childhood • Born: May 12, 1820 • Florence was born in Italy while her English parents were traveling. She was named for the city of her birth. • Wealthy parents. • Taught by private tutors.

3. Victorian Hospitals and Medicine • Operations were a last resort. Almost half of a surgeon’s patients died from blood poisoning because the importance of hygiene was not fully understood. And death in childbirth was an “expected tragedy” for many women. • When Florence was a young woman, hospitals were places where the poor went to die, not places to be cured. Beds were dirty, wards overcrowded and nursing inadequate. Those who could afford a doctor and nurse were treated at home.

4. Hospitals • Hospitals were dirty and smelly. • Patients drank whiskey to relieve pain. • Nurses drank too and didn’t know much about diseases. • Basically servants who washed and cooked.

5. Growing up in the Industrial Revolution • Florence lived through the industrial revolution. It was an age of new inventions – steamships and the railway, the telegraph and photography – and increasing trade and industry, all celebrated in the Great Exhibition of 1851. The explosive growth of cities brought with it huge social problems and high death rates. Although protected by her family’s wealth, Florence witnessed poverty in the countryside where she grew up, and in cities across Europe that she visited.

6. Growing up in the Industrial Revolution • People moved to cities to find work. They found overcrowded and unsanitary conditions. Until sewers were dug and clean water supplied, outbreaks of infectious diseases, such as cholera, typhus and dysentery, killed thousands. Two in every five children died before they were five years old in mid-19th century London.

7. God’s Call to Nurse • Florence felt from a young age that God was “calling” her. But she did not know for years what her vocation should be. Her Christian faith was the driving force throughout her life. She believed in helping others less fortunate than herself by understanding God’s laws and his will through statistics.

8. Young Adulthood • September 1837 • Traveled to France, Italy and Switzerland • Attended concerts, operas, and elegant parties • 1839 • Presented to Queen Victoria of England

9. Good Samaritan • 1840s England • Hungry people, crowded hospitals and prisons • Florence brought food, clothing, and medicine • She helped the sick • 1844 • Just before her 17th birthday, Florence felt she heard God’s “voice” speaking to her. This happened soon after she had discovered a talent for nursing while caring for her family and their servants during a flu epidemic.

10. Marriage? • Richard Monckton Milnes asked her to marry him many times. • She adored him, but turned him down. • She did not want to be a wife like her mother “making society and arranging domestic things.”

11. God’s Call to Nurse • She gradually felt that God was calling her to be a nurse – a shocking idea then. Nursing was not a job for an intelligent, good-looking young woman like Florence. Only working class women nursed for a living. • December 1845 • She told her parents she wanted to be a nurse • Nightingales horrified by Florence’s plans. • She became depressed and sickly. • June 1851 parents finally relented.

12. Training at Age 31 in June 1851 • Florence first trained to be a nurse at Kaiserswerth, a religious community near Dusseldorf in Germany, where a Protestant pastor, Theodore Fliedner, and his wife ran a hospital, orphanage, and college. Florence learned about medicines, how to dress wounds, observed amputations and cared for the sick and dying. She had never felt happier. “Now I know what it is to love life,” she wrote.

13. Florence Escapes the Gilded Cage • In 1853 she went to Paris, France to visit hospitals and watch doctors at work. • Back in England, Florence’s mother finally allowed her daughter to nurse. She was made superintendent of The Institution for the Care of Sick Gentlewomen, a small women’s hospital in London’s Harley Street in 1853. • Insisted on a clean hospital • Opened to all needing care, not just Church of England members. • Her father gave her a generous allowance of £500 ($50,000) a year.

14. Florence Escapes the Gilded Cage • When an epidemic of cholera broke out in London in 1854, Florence rushed to nurse victims in the nearby Middlesex Hospital. Cholera, an infection of the intestine by the bacterium Vibrio cholerae, causes acute diarrhea and can be fatal within hours. It killed thousands during the 19th century. • That summer Britain and France joined their ally Turkey and declared war against Russia.

15. Joseph Lister • Joseph Lister’s use of a fine spray of carbolic acid as an antiseptic dramatically improved patients’ survival rates in the 1860s. Pain relief during labor became socially acceptable when Queen Victoria received the new anesthetic chloroform during the birth of her fourth child in 1853.

16. Crimean War (1853-56) • Mostly remembered for three things: the Charge of the Light Brigade, mismanagement in the British army and Florence Nightingale. The war was fought between Russia and the allied powers of Britain, France and Turkey. It began because of British and French distrust of Russia's ambitions in the Balkans. • The war was ended by the Treaty of Paris in 1856. The scandal surrounding British losses through disease in the Military Hospitals led to a Royal Commission into Military Hospitals

17. Crimean War • 1854 England joined the war against Russia. • Not enough beds or doctors • No candles, bandages, or nurses • October 15, 1854, Secretary at War asked Florence to take a small group of nurses to Crimea. • Shocked upon arrival • Fleas and rats everywhere • Injured soldiers on dirty beds and the floor • Ended in March 1856

18. Training Nightingale Nurses • Florence became actively involved in the Nightingale School at St. Thomas’ in the 1870s in order to avert a crisis. The first student nurses, or “probationers” were receiving little formal training. A student from Sweden complained that in 8 months she has only learned how “to be obedient and humble and not think so much of herself.” The drop-out rate was alarmingly high. • Once Florence learnt this she set about reforms, appointing a new sister and involving the St. Thomas’ surgeon, John Croft, to give lectures and set examinations. Florence began to meet regularly with the students and the sisters, taking a personal interest in their welfare and careers. • Nightingale nurses took up posts as matrons in hospitals all over the world. Many went on to lead the reform of nursing and raise its status into a profession.

19. The Human Cost of War • Soldiers were killed or wounded by bullets and flying shrapnel from cannon balls. Sword and lance injuries were relatively uncommon except among the cavalry. Wounds to the chest and stomach were almost always fatal. Mental scars went unrecorded – these were the days when shell shock was diagnosed as cowardice, not an injury. • During the Crimean War army surgeons operated in tents on the battlefield, amputating limbs, extracting bullets, dressing and sewing wounds. Traditionally, doctors used the guillotine method for amputations, where the limb was cut straight off. In the war they began to use the flap technique, which left more skin to help close the wound. • Cholera, typhoid, and dysentery accounted for nearly 4 times the number of deaths than battle injuries during the war. The cold wet and hunger during the bitter winters were terrible, as was the journey over rugged land and sea to the base hospitals in Scutari.

20. Treating the Wounded • The great battles of the Crimean War – Alma, Inkerman, Balaklava and the siege of Sebastapol – killed far fewer British soldiers than disease. • Men were burnt by exploding ammunition. During the ill-fated Charge of the Light Brigade, the cavalry was cut down by Russian cannon fire. • British army doctors were reluctant to use the new anesthetics, ether and chloroform, when amputating an arm or leg. They believed, as Dr. John Hall, the chief of medical staff, said “It is much better to hear a man bawl lustily, than see him sink silently into his grave.” • On the Russian side, the army surgeon, Nikolai Pirogov, emerged as the medical here of the Crimean War. He used anesthetics, plaster casts for setting bones and developed triage by sorting casualties according to those who would benefit most from treatment. Pirogov also welcomed women as nurses. One teenage nurse became famous as “Dasha of Sebastapol” for her courage during the terrible siege of that city.

21. Florence Goes to War • Florence was at home when she read about the disaster facing the British army in the autumn of 1854. Hundreds of soldiers sent to fight with the French and Ottoman Turks against the Tsar’s Russian army in the Crimea were dying of disease. • The British military hospitals at Scutari, a suburb of Constantinople (now Uskudar, Istanbul), could not cope. When the wounded arrived by boatloads the conditions became horrific. Must men die in “agony” and “unheeded” demanded The Times’ reporter in Turkey. The scandal provoked a public outcry. • Sidney Herbert, the secretary of state at war, wrote to Florence asking her to help by leading a group of women nurses – a new and risky idea. Florence has already written offering to go. She and her team of 38 brave women set sail for Scutari right away, leaving in a blaze of publicity. They arrived at the hospitals to find the crisis much worse than they imagined.

22. Florence Works Day and Night • Florence realized the military hospitals needed to be properly managed. She worked without rest, organizing the nurses and soldiers’ wives to clean shirts and sheets, and men to empty the toilets. She bombarded Sidney Herbert in London with letters asking for supplies and used her own money, and funds sent by the public via The Times, to buy scrubbing brushes, blankets, bedpans, and even operating tables. Every night she walked miles of hospital corridors where thousands of casualties lay. The men worshipped her.

23. Nursing • Florence and the nurses cleaned the hospital, prepared better food, and cared for the sick. • Soldiers called her “The Lady with the Lamp” because every night she walked for hours from bed to bed checking on their comfort. • Some tried to kiss her shadow • Sometimes she would work through the night without sleep.

24. The Lady with the Lamp • The first image showing Florence as the “Lady with the Lamp” appeared in the illustrated London news early in 1855. As the war dragged on with few victories to report, Florence’s courage made her internationally famous. Florence hated what she called the “buzz” of celebrity. But she knew how to use public opinion, and Queen Victoria’s personal support to silence her critics. Fame gave her power, but she feared it obscured others’ achievements and the human cost of the war. • The burden of Florence’s sudden fame fell on her parents and especially, Parthenope (Greek name for Naples), her sister. Parthenope wrote hundreds of letters to family, friends, and acquaintances to spread the word about Florence’s work. She tried to manage her image but also to respect Florence’s desire for privacy. This only fueled the legend and the saintly image of Florence nursing alone by lamplight. Florence’s image appeared, often quite unrecognizably, as pottery figurines, on souvenirs and even on paper bags. Songs and poems were written about her. When the US poet, Henry Wadsworth Longfellow wrote “Santa Filomena” in 1857, it fixed forever Florence’s image as the lady with the lamp.

25. Working Day and Night • Alexis Soyer, a French-born chef, helped Florence reorganize the kitchens. In May Florence and Soyer sailed to the Crimea. A few days after her arrival she collapsed with “Crimean Fever” and almost died. She never fully recovered but she worked until the war ended.

26. Sickness • May 1855 • For two weeks she was near death • She recovered and within a few months was back at work • English people loved her • Money was collected for the “Nightingale Fund” • Mostly donated by soldiers • She used it to set up a school for nurses • Poems and songs were written about her • Babies were named after her

27. Alexis Soyer • On 2 February 1855, he wrote to The Times offering to go to the Crimea at his own expense to advise on cooking for the army. He worked in close liaison with Florence to correct the diets in the hospitals and travelled with her to Balaclava in May 1855. He reorganized hospital kitchens, invented new dishes from standard rations and organized that each regiment had a trained chef who would collect rations and prepare food for the men. • He designed more efficient cooking utensils, including the “Scutari teapot” and the “Soyer Field Stove” which the British Army was still using 120 years later. • Like Florence, Soyer caught “Crimean Fever” but remained in the Crimea until the end of the war. He was ill when he returned home and wrote his final book "Culinary Campaign' in 1857. He died of fever on 5 August 1858 and was buried in Kensal Green cemetery.

28. After the War • Due to so many deaths, Florence did not feel like celebrating so came home quietly. (Age 36) • She was very ill again in 1857 and 1861. • Florence spent the rest of her life at home where she worked. • Surrounded by papers, notebooks, and cats.

29. Florence and India • British troops were fighting a rebellion in India within a year of the Crimean War. Prompted by the Indian Mutiny of 1857 (Sepoy Rebellion), Florence began to investigate the army’s health there. Soldiers, like the population in general, were dying because of lack of clean water and poor sanitation. Florence began a life-long campaign to improve the health of all Indians, not just British soldiers. • Florence lobbied for a Royal Commission into the state of the army in India. Working with her trusted collaborators she gathered the facts, often by questionnaires, and analyzed the data. When the final report was published she mobilized support, and fought a long and often frustrating battle for reform. • Florence never visited India, but she became an authority on the sub-continent, which included modern-day Pakistan, and Bangladesh. The health of the poor remained her constant concern for the rest of her working life. Unlike many in power, she felt that every famine was an avoidable tragedy.

30. Writing and Effects • Two books were published in 1859 • Notes on Nursing • Notes on Hospitals • 1860 The Nightingale Training School for Nurses opened in London • Many of the “Nightingales” came for her blessing before they began their work • If they were sent to a far-off place, Florence sent flowers there to greet her when she arrived.

31. Nightingale’s Notes on Nursing • Florence wrote Notes on Nursing to help ordinary women care for their families. She stressed the importance of observing their patient’s symptoms and needs, as well as the importance of cleanliness, warmth, fresh air, light, and a correct diet. Published in January 1860, it became a bestseller. Queen Victoria was a grateful reader. Soon translated into German, French, Italian, and other languages, in the US a pirated version was frequently reprinted.

32. Nightingale’s Notes on Nursing • Florence included practical hints and notes. A woman who rustles, “is a horror of a patient,” she wrote, for example. “The fidget” of a crinoline dress or creaking stays will do more harm than any medicine will do good, she declared. • Florence, like her contemporaries, believed that diseases were caused by miasmas or foul, infected air. It was not until 1867 that Joseph Lister argued that germs caused disease. Although the theory of miasma was inaccurate, hygiene and sanitation worked because it removed germs. Florence ultimately accepted germ theory but stressed that prevention through cleanliness was better than the cure.

33. Improving Medical Care • Queen Victoria admired her push for improving medical care for British soldiers • A Royal Commission was appointed • Florence gave the commission a 1000 page report, Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army. • As a result of her work, living conditions and medical care improved.

34. Impact on World • 1861 • Advised U.S. Secretary of War on setting up army hospitals for those injured in the American Civil War. • Advised on improving health conditions in India. • Nursing Schools established in Europe and America followed example of Nightingale School.

35. Honors and Death • 1907 (age 87) • Awarded Order of Merit by King Edward VII of England. • The first woman to receive the award. • August 13, 1910 • At the age of 90 she died quietly in her sleep

36. Florence Nightingale’s Legacy • Helped make hospitals clean and efficient. • helped make nursing an important, respected profession. • Helped change the world around her into a better, more caring place.