Shining Light
In an effort to disentangle myth from reality, historians look past the defenders and detractors to focus on the substance of Florence Nightingale's life and the true nature of her contributions (First in a two-part series)

By Glen Fest
October 8, 2003


In the only words she ever would commit to an audio recording, a 70-year-old Florence Nightingale spoke warmly of the British soldiers who served in the valleys of the Ukraine decades earlier.

"When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life," Nightingale said in 1890, in a proper, lilting Victorian inflection. "God bless my dear old comrades of Balaclava."

Whether in her own words or those of poets, "The Lady with the Lamp" seems forever linked to her supremely humane service near the frontlines of the Crimean War in the 1850s. Her dedicated work in caring for soldiers in a hellish army barracks hospital gave rise to verse and song back in England. It also seeded the selfless, nurturing vision of modern nursing that ensconced her name for the ages.

But unlike eminent 19th century giants Dickens or Darwin, Nightingale's well-known legend does not reflect her most seminal and impressive feats, according to several Nightingale scholars. Besides creating the first training school that elevated nursing to a respectable profession, she was a pioneer in statistical research and community health. Her ideas on hospital design and function helped modernize dysfunctional facilities that were death traps for residents.

The general public, and often nurses themselves, know little beyond the cursory facts of Nightingale's history, experts say. Several of her contributions are overlooked in nursing school curricula and historical revisionists have made an industry of deriding the classic angel-of-mercy image. Some also delve into arguably trivial debates about her mental state, personality and even sexuality.

"I'm not sure her status or her reputation overwhelmed her record of achievement, but I think it did distort it," said another scholar, Linda Freeman, DNS, RN, a professor of nursing at the University of Louisville in Kentucky. "Really, the myths surrounding her aren't as interesting as the real person."

Several Nightingale scholars and medical historians have opened a new campaign of validation, hoping to shift the dialogue toward the substance of her remarkable life and reminding the nursing movement of her continuing relevance.

Misunderstood, misread

A British nurses' labor union grabbed headlines in 1999 when it voted to disavow its movement from Florence Nightingale. The union decried her Caucasian, upper-class image as unfit for modern, multicultural nursing and accused her of symbolizing hierarchical and submissive structures that kept nurses under the "boot" of physicians and hospital administrators.

The union, likening its revolt to the post-Cold War toppling of Lenin statues in Moscow, even suggested disassociating International Nurses' Day from Nightingale's May 12 birthday.

"If they knew more about the full Nightingale, they would see her as a model for today's nurse, not just a bedside nurse of the past," said Lois Monteiro, Ph.D., MSN, RN, a professor of community health and sociology at Brown University in Providence, R.I., and longtime Nightingale letters researcher.

Many researchers say Nightingale was not a meek, docile cherub, but instead a sure-minded and steel-willed administrator. She made life palpable for patients by making it unbearable for belligerent hospital committees and military bureaucrats during her most influential years from the 1850s to the 1870s.

Although it may be uncomfortable to read about the humiliating behavioral oversight or horrendous working hours that Nightingale's probationary nurses went through, her ultimate vision was their empowerment, nursing scholar Deva-Marie Beck, Ph.D., RN, said.

"It's important when we look at Nightingale and her works that we look at them through that Victorian lens," said Beck, a speaker at U.S. and international ceremonies commemorating Nightingale and co-author of a forthcoming book on the application of Nightingale's legacy to the 21st century.

Victorian women could not vote or own property, Beck said, and first realized the possibilities of working outside the home only when Nightingale formed her nursing school at London's St. Thomas' Hospital in 1860. Scholars say nursing itself at that time was saddled with a reputation as the work for slovenly, drunken housemaids who fell into the field for want of marriage or a higher social standing.

"As a result, her training program caught on just at the perfect time in history," Beck said.

The role of women in Victorian society is an undercurrent of Nightingale's career, many researchers say, because of the professional and cultural barriers she faced despite a wealthy, well-educated background. Overcoming family objections to a nursing career in her mid-20s was only the beginning.

Early years

Florence Nightingale grew up the youngest daughter of a Cambridge-educated father who endowed her with a comfortable childhood and a home-taught education steeped in literature, history, languages and mathematics. In her teens and early 20s, she became enamored with social causes of the day, including the welfare of Britain's easily forgotten poor.

Although her family forbade her to work as a nurse at an infirmary near their Embley home, Nightingale began studying British hospitals and making trips abroad to train and read up on health practices in France, Egypt, Rome and Germany.

Much of what she read, learned and trained for in those formative years was applied in her first job as a nursing superintendent for a women's hospital on Upper Harley Street in London (a job she took without a salary, as "ladies did not accept pay," Monteiro said).

Nightingale immediately made several substantial changes to nursing practice at the hospital. She arranged for the installation of a bell system for patients to call for nurses' help. She had hot water piped to upper floors and established centralized nurses' stations. She also learned to budget and organize her unit, and brought better resources for food and medicine to the hospital. She turned her eye on administrative practices of the hospital, demanding it open to Catholic and Jewish patients.

Nightingale changed the role of nurses by shifting their menial housecleaning chores to other workers, and moved nurse's stations from remote sites to on-floor units. She also visited other London hospitals to research methods for improving working and training conditions for hospital nurses.

"It gave her administrative experience on how to budget and organize and so on," said Lynn McDonald, Ph.D., a Canadian university professor of sociology and a prominent Nightingale researcher. "Of course, what she wanted to do was to nurse the sick poor. And the [Harley Street institution] was not truly where her heart was."

Medical reforms

Best known for Florence Nightingale and "The Charge of the Light Brigade," the 1853-56 Crimean War is most notable in history for its impact on the century to come. A British-French alliance pushed Russia off the imperialist stage and led to the rise of Germany and Italy into nation-states with the end of the old post-Napoleonic coalitions.

What also resonated from the war was a collective cry for medical reforms from a British public repulsed by the conditions their soldiers encountered in Crimea.

The British army carelessly squandered lives by mismanaging its supplies and equipment. At an army barracks hospital hurriedly set up in Turkey across the Black Sea from the Ukraine, thousands of ill and wounded soldiers were packed into overcrowded, unventilated areas without proper food, clothing, bedding and basic medical supplies such as bandages and medicine, according to historians. The conditions at the Scutari army barracks hospital were worsened by the presence of rats, cholera and flowing sewage that ran down the center of large, unventilated hospital corridors.

Of roughly 22,000 English deaths from 1854-56, more than 17,000 were from non-combat-related causes like disease, starvation and exposure. Army and government officials accustomed to treating soldiers as "scum" and "black sheep" were nonplussed at the public's shock from reading the dispatches from the first-ever war correspondents that accompanied the troops to battle, according to Cecil Woodham-Smith's 1950 biography of Nightingale.

The British public's support for the war quickly waned. "Crimea was for Britain what Vietnam was for us," Beck said.

Nightingale, moved by the plight of the soldiers and accepting an invitation from war secretary Sidney Herbert, formed a team of 38 nurses to head to Turkey and aid the soldiers suffering in the Scutari facility outside of Constantinople (now Istanbul).

"She was told everything was fine, but of course it was appalling," McDonald said.

Nightingale arrived with her team in November 1854, to a less-than-warm greeting from the overworked physicians and unimpressed pencil pushers responsible for the army's chaotic provisional methods. No extra clothing or eating utensils were initially provided for the wounded, for example, because the army expected wounded soldiers to carry these items with them from the battlefield.

"She had a number of people and military officers, who carried on an adversarial relationship because she brought attention to the conditions they were responsible for," Beck said. Nightingale's service "was only 21 months total, [in which] she essentially worked around the clock."

Monteiro said Nightingale tended to the soldiers' social needs as well, such as fighting for new regulations that allowed soldiers to send their pay directly home to families. She wrote thousands of letters for injured or dying soldiers, and offered them books, games and "amusements" that occupied their time-and distracted them from the temptations of drinking and prostitution that traditionally were in the periphery of such military encampments, researchers say.

Fame in England

"Angels With Sweet Approving Smiles." "The Star in the East." "The Shadow on the Pillow." "The Soldier's Cheer."

Nightingale was the subject of a virtual hit parade of popular songs while she was still in Turkey. A penny-priced, quick-turn biography of her hit the streets, and the attention only multiplied when Nightingale herself was stricken with disease while attending the front-and refused to leave.

Hearing of the acclaim did not impress her, scholars say. "She didn't want to get her fame on the backs of the soldiers who had died," Monteiro said. "She rejected celebrity."

But Nightingale did not reject the attention out-of-hand. As in her Harley Street days, she was eager to bring changes for hospitals and nursing, and knew she now had the ear of some powerful people, like Sidney Herbert.

Nightingale wrote more than 30 unofficial letters to Herbert while in Turkey, suggesting changes to hospital and army procurement methods. Woodham-Smith and other historians say Nightingale was a key instigator in establishing a sanitary commission in January 1855 to investigate the climbing mortality rates at the Army barracks hospital. She worked behind the scenes because women could not sit on the commission or even bring formal testimony.

The commission's findings, which presented astonishing descriptions of cesspool sewer systems and dead animals in the hospital's water supply, led to immediate improvements in sanitation at the Scutari facility, by lime-washing walls, clearing out underground sewage systems and ridding the place of vermin.

Ironically, the lifesaving work of the 1855 sanitation commission is commonly cited in criticism of Nightingale. Some historians during the past few decades have derided her work in the Crimean War, most specifically in charges that "The Lady with the Lamp" had nothing to do with actually saving lives at the hospital.

Blaming Nightingale

A BBC-authored biography of Nightingale states that "historians are waking up to the shocking truth" that death rates at her hospital were higher than at other Army hospitals, and her "lack of knowledge of the disastrous sanitary conditions at Scutari was responsible." The BBC concludes that Nightingale managed only to "help [soldiers] die in cleaner surrounding and greater comfort, but she had not saved their lives."

It's a claim that infuriates many other historians, including McDonald. While true that Nightingale never took individual credit for cleaning up the hospital or saving lives, McDonald said it is "preposterous" to assert that Nightingale is accountable for not understanding the full extent of sanitation issues upon her arrival, much less the engineering, sewers, rats and water supply for a site she inherited.

"She led the team, they worked like fiends, they instituted a number of improvements and then when the engineering was redone, then they began to get results from the combined effort," McDonald said.

Nightingale's Crimean War service was the first of many controversies she was to entangle-or to engender-about herself for decades to come, and well past her death in 1910. All this, despite that she became a near-recluse for the rest of her life, rarely making public appearances because of a chronic illness (believed to be brucellosis) acquired from the war.

From her home, and sometimes her bed, scholars say Nightingale still wrote, studied and dreamed of revolutionary changes in nursing and hospitals, as well as the global health of the world's poorest and most vulnerable peoples.

Contact Glen Fest at glenf@nurseweek.com