Nightingale, Florence

(1820-1910), reformer of Army Medical Services and of nursing organization

by Monica E. Baly and H. C. G. Matthew

© Oxford University Press 2004 All rights reserved

Nightingale, Florence (1820-1910), reformer of Army Medical Services and of nursing organization, was born on 12 May 1820 at Villa Columbia, Florence, where her parents were on a European tour. Their other daughter, Frances Parthenope Nightingale (1819-1890) [see Verney, Frances Parthenope], born in Naples, had been given the classical name of her birthplace. Their father, William Edward Nightingale (1794-1874), son of William Shore, a Sheffield banker, had inherited Derbyshire estates from his uncle, Peter Nightingale, and had changed his name by royal warrant. W. E. N., as he was known to friends, was handsome and cultivated, with a reputation for wit. In 1818 he married Frances Smith (1789-1880), daughter of William Smith, a Unitarian and supporter of dissenters. Frances was the beauty of this distinguished family of five brothers and five sisters, most of whom married into prosperous, intellectual families, thus supplying the Nightingale girls with numerous relatives who were an important factor in their lives; several were later associated with Florence in her work.

Early life
In 1826 William Nightingale bought Embley Park in Hampshire, and the family routine was to spend summer at Lea Hurst in Derbyshire, and winter at Embley with visits to London interspersed with visits to and from relatives. Although in private notes as an adolescent Florence railed against the empty life of her parents, and though biographers have represented Mr Nightingale as an 'amiable dilettante', he took his squirearchical duties seriously. As a dedicated educationist he supported schools on his estates at personal expense; in 1834 he stood as a whig for Andover on a distinctly radical manifesto; he was high sheriff in 1829; and he supervised the education of his daughters. Finding Florence an apt pupil he gave her a sound education in classics, philosophy, and modern and classical languages. Biographers, particularly feminists, anxious to portray Florence as the frustrated Victorian daughter, have tended to depict her mother, known as Fanny, as merely a pleasure-seeking hostess, but she attracted some of the best intellects of the day, including Lord Ashley, the editor of The Times John Delane, the eminent theologian Chevalier Christian Bunsen, the prison architect Sir Joshua Jebb, the historian Leopold von Ranke, and many others. Florence met and enjoyed the company. In private notes she wrote 'I must overcome my desire to shine in company', but she undoubtedly did shine and enjoy it.

Although she did not inherit her mother's beauty Florence was described by Mrs Gaskell as 'tall, willowy in figure, [with] thick shortish rich brown hair, a delicate complexion, and grey eyes that are generally pensive but could be the merriest' (Cook, 1.39). Florence was a good mimic, attractive to men, and had a number of suitors; many of the men she met through her parents remained lifelong friends. Half the Nightingale Fund council was originally known to her through her parents.

In spite of these advantages Florence Nightingale was an unhappy young woman. She suffered from bouts of depression and feelings of unworthiness, and she questioned the purpose of life for the upper classes. Unlike her mother and sister, who were content to do good works on the estates, she pondered on the need for charity and the causes of poverty and unemployment. At the age of sixteen she recorded that on 7 February 1837 'God had called her to His service', though what God wanted her to do was unclear. She became interested in the mystics and studied the lives of people such as St Teresa of Avila and St John of the Cross, and with the help of Bunsen she studied Schopenhauer and the new biblical criticism. At the same time Julius Mohl, who had married Mary Clarke, a friend of the Nightingales, interested her in comparative religion. Looking for scope to give service she found none in the Church of England, and in 1845 she tried to persuade her parents to let her go to Salisbury Infirmary to nurse. Not surprisingly they refused. Her private notes became more despairing and dramatic, seeing 'nothing in life but death'. From these depths she was rescued by Charles and Selina Bracebridge, to whom she became strongly attached, and who persuaded her parents to let her travel with them to Rome for the winter of 1847-8. There she met Sidney Herbert and his wife, (Mary) Elizabeth Herbert, whose social concerns she shared and with whom she became friends. Her contacts with Sidney Herbert were to be of central importance to her later national prominence. During this visit she also met Madre Santa Columba, who became her spiritual mentor, at the convent of the Trinità dei Monti, where she became convinced that she had a mission from God to the sick.

In 1850, during travels with the Bracebridges and on the advice of Bunsen, Florence contrived a visit to the religious community at Kaiserwerth-am-Rhein. This was a turning point in her life: she felt that Pastor Theodor Fliedner and the deaconesses were doing God's work, with women of humble birth devoting their lives to the sick and the deprived. Later she denied that she had 'trained' at Kaiserwerth, saying that 'The nursing was nil and the hygiene horrible' (As Miss Nightingale Said, 11), but that she had never seen purer devotion. Here she saw a possibility of changing nursing, not on the lines of the sisterhoods, where the 'ladies' supervised and nurses did the menial work, but by training suitably motivated women of any class. Her anonymous account of the community, The Institution of Kaiserwerth on the Rhine, for the Practical Training of Deaconesses, etc. (1851), printed 'by the inmates of the London Ragged Colonial Training School', was her first publication.

Florence returned to England and was again at odds with her parents. She finally refused marriage with Richard Monckton Milnes, later Baron Houghton, who had wooed her for nine years, a union that would have delighted her parents. The rejection came hard, for Monckton Milnes seems to have understood her more than most. He was to remain a valued member of the Nightingale council until his death in 1885. Florence was not the only thwarted daughter: Parthe, with her own peculiar gifts, still unmarried, became ill and obsessive about her sister (Woodham-Smith, 84-8). Sir James Clark, the family physician, with considerable perspicacity advised that Florence leave home, and the Herberts suggested that she should accept the post of unpaid superintendent to the Institute for Sick Governesses in Distressed Circumstances in Harley Street, London, of which a friend, Lady Canning, was the chairman. Before taking up the post Nightingale paid another visit to the Sisters of Charity in Paris (after taking the advice of H. E. Manning), visited other hospitals, and continued studying the blue books, making herself an expert on hospital administration. Once installed at the institute in August 1853 she impressed all who came into contact with her, including Dr Bence Jones, who was considering starting a training school for nurses at St George's Hospital, and William Bowman, with her skill both as a nurse and as an organizer. She demanded improvements in the facilities and threatened resignation unless Roman Catholics and Jews could be admitted as patients (Smith, 11). In August 1854, while she was at Harley Street, there was a devastating epidemic of cholera in Soho, and Nightingale went to help with the flood of patients overwhelming the Middlesex Hospital. These early experiences showed her to have a remarkable flair for imposing her will on institutions, as well as 'an extraordinarily rich and firm imaginative grasp of the relations between individuals and the siting and working of things and of human beings' relations to them' (ibid., 12).

The Crimean War
The Crimean War broke out in March 1854, and in September British and French troops disembarked for the invasion of the Crimea. In October William Howard Russell sent dispatches to The Times in which he described the neglect of the wounded and the lack of nurses (The Times, 9, 12, 15, and 29 Oct 1854). Much of the public indignation fell on the head of Sidney Herbert, now secretary of state at war, who on 15 October wrote to Nightingale, asking her to take a party of nurses, at the government's expense, to Scutari. The letter crossed with one from Nightingale herself to Elizabeth Herbert offering to take a small private expedition, evidently the consolidation of an emerging plan (Smith, 26). On 16 October Nightingale met Sidney Herbert and the matter was arranged. 'Florence is sole leader', her sister recorded (ibid., 27). With the aid of Lady Canning and Elizabeth Herbert, within five days a party of thirty-eight nurses was assembled, consisting of fourteen professionals and twenty-four from religious sisterhoods, including five Catholic nuns from Bermondsey, five from Norwood, and fourteen from Anglican sisterhoods. The party, accompanied by Mr and Mrs Bracebridge, arrived at Scutari on 5 November and climbed the slopes to the enormous dilapidated Turkish barracks, over which Florence Nightingale said should have been inscribed Dante's words 'All hope abandon, ye who enter here.'

At Scutari, on the Asiatic side of the Bosphorus, opposite Constantinople, were four hospitals to house wounded troops brought by ship across the Black Sea from the battleground. The nursing party was received with sullen opposition by doctors and officials (Cook, 1.182). Nightingale at once began to assert her authority and to use her influence in London (which she was careful to see was apparent to those at Scutari) to improve the conditions in the hospitals, especially with respect to hygiene. She used money from the Times fund to buy needed equipment locally and to make up palliasses. When 125 Turkish workers struck for more money, she dismissed them and hired Greeks (Smith, 37). She organized and improved the quality of the male nursing orderlies, who did the bulk of the nursing. Professor Smith calculates that Nightingale had dismissed thirteen of her original female nursing contingent by Christmas 1854.

The battle of Balaklava dramatized the need for good nursing, and as the sick and wounded were brought across the Black Sea the doctors turned to the Nightingale party for help on 9 November 1855 (Woodham-Smith, 168-70). For the next six months the doctors and nurses battled against overwhelming odds. Not only were they nursing 4 miles of patients but, because of the breakdown in purveying, Nightingale was acting as quartermaster. In January 1855 she wrote to Sidney Herbert 'Nursing is the least of the functions into which I have been forced' (As Miss Nightingale Said, 34). Appalled by the inadequate feeding arrangements she persuaded Lord Panmure, secretary of state for war, to arrange for Alexis Soyer, chef at the Reform Club, to come out and reorganize the cooking, though it was standard practice for male nursing orderlies to be responsible for providing their patients' meals.

While Nightingale was coping with the nursing, welfare, and rehabilitation of the sick, her task was complicated by the arrival of parties of nuns and 'lady ecclesiastics', sent as reinforcements by Herbert and led by Mary Stanley and Mother Mary Frances Bridgeman. Nightingale was furious at the absence of consultation and threatened resignation. She rightly saw that the new party affected her position as 'sole leader'. She was also alarmed both by the high proportion of Roman Catholics, a sensitive issue because of defections to Rome at the time, and, more important, because she regarded her experiment as the opportunity to prove the value of female nursing in wartime: to achieve this there had to be discipline, and she had to be in control. That she was autocratic there is no doubt, and her dealings with Mary Stanley seem harsh; she thought Sidney Herbert had betrayed her by allowing these missions, and on 3 April 1856 she reminded him: 'Your letter is written from Belgrave Square, I write from a hut in the Crimea. The point of site is different' (As Miss Nightingale Said, 40). This determination to remain in control and the acerbic way she dealt with would-be helpers gave fodder to later biographers counteracting the 'ministering angel' legend (Smith, chap. 2).

Nightingale proved a formidable administrator and organizer, and her role at Scutari was, like that of her male colleagues and predecessors, as much that of a 'General Purveyor', as she described herself, as of a medical nurse. The acquisition of clothing and equipment, given the priorities of war and the disorganization of the suppliers in Britain, was in itself a striking achievement. Although her duties were chiefly administrative, she made a point of visiting the wards: a Chelsea pensioner later recalled, perhaps with some exaggeration: 'Miss Nightingale was always coming in and out. She used to attend to all the worst cases herself' (Cook, 1.235). Her insistence on uniform, discipline, and orderly procedures in the midst of considerable squalor set a standard that permanently affected the self-esteem of what became the British nursing profession. Mary Stanley thus described her in December 1854:

there sat dear Flo writing on a small unpainted deal table. I never saw her looking better. She had on her black merino, trimmed with black velvet, clean linen collar and cuffs, apron, white cap with a black handkerchief tied over it. (ibid., 1.234)
In May 1855 Florence Nightingale crossed to the Crimea to inspect the war hospitals, and while there collapsed and was dangerously ill with 'Crimean fever', which she referred to as 'typhus' but which was probably Brucella melinites, or perhaps Brucella melitensis (D. A. B. Young, BMJ, 23 Dec 1995, vol. 311). Nursed by the devoted Selina Bracebridge, Nightingale made a slow and painful recovery. She resisted efforts by officials to ship her home and returned to Scutari to continue working; in all she made three inspections of the Crimea, and on Good Friday 1856 she was given full jurisdiction over 'the East' (Smith, 63).

When the news of her illness reached Britain there were prayers for her recovery, the queen asked to be kept informed, poems were addressed to her, and The Times referred to her as 'The Lady of the Lamp'. A description of her midnight vigils by Mr Macdonald, the Times almoner in the Crimea, defined what quickly became her iconic stature and anticipated the depiction, not only of Florence Nightingale but of nurses generally, in a thousand novels and films:

She is a 'ministering angel' without 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. (Cook, 1.237)
Henry Longfellow's poem of 1856 became one of the best-known of Victorian verses:
Lo! in that hour of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
Sidney Herbert wrote 'There broke out in different parts of the country a feeling of immediate and spontaneous expression of public gratitude and isolated portions of the country were preparing to make gifts to her.' With the advice of the Nightingale family it was decided to co-ordinate this response into a national appeal to 'enable Miss Nightingale to carry out a service close to her heart'. In November 1855 a public meeting was held in Willis Rooms, St James, London, with the duke of Cambridge in the chair. A report was sent to Nightingale in Scutari, who was asked by the trustees of the fund for her plans for its use. Beset by the problems of giving evidence to the sanitary commission sent out by Lord Panmure, the internecine squabbling, and the organization of the hospital, she replied with logic, if asperity, 'If I had asked for a Fund you might have asked me for a plan': she had not asked and she had no plan. The fund, which raised £45,000, she came to see as a millstone.

The war ended in June 1856 with little cause for rejoicing. Out of 94,000 men sent to the war area, 1760 died of wounds but 16,300 died of disease, and 13,000 were invalided (Smith, 73). As she had questioned the causes of poverty, Nightingale now questioned the reasons behind this preventable death-rate. She recognized, as few people did, the grievances of the ordinary soldier and she wrote, time and again, 'I stand at the altar of murdered men and while I live I will fight their cause'.

Return to England: royal commission
Florence Nightingale returned to England in July 1856 a changed woman. Emaciated and tense, and weighed down with the burden she felt had been placed on her, she realized that if such suffering were never to happen again the Army Medical Service, and, if necessary, the army itself, must be reformed. To this end she set about asking for a royal commission. She set up what became known as her 'reform cabinet', a group of well-placed male advisers. In September 1856 she was invited to Balmoral and established what was to be a highly effective relationship with the queen and Albert. On 16 November 1856 it was agreed at an interview she had with Lord Panmure that a commission would be established, but nothing followed. Having used influential allies, royal approbation, and the threat to publish her own report, eventually in April 1857 Nightingale saw a commission established with four subcommittees and Sidney Herbert as chairman. Notes on matters affecting the health, efficiency, and hospital administration of the British army (1858), her own report of 830 pages, printed and privately circulated but never published, was backed by statistical evidence that showed how much of mortality was due to the state of the hospitals. The causes of the Crimean disaster were examined and a comparison made between the death-rate of the army in peacetime and the civilian rate, Nightingale's conclusion being 'Our soldiers are enlisted to die in barracks'. Her report constitutes 'an astonishing example of her gift for imagining palpable needs and assembling workable remedies' (Smith, 81). The reforms set in train as a result of the commission marked a turning point in the Army Medical Service. With respect to the commission, Nightingale was, as E. T. Cook put it, 'an unremitting task-master' (Cook, 1.356); but F. B. Smith argues that she was lax about preparing her witnesses and gave the impression 'that she did the work while Herbert played the dilettante figure-head', when the opposite was in fact the case; moreover, 'behind Herbert's back she was envious and disparaging' (Smith, 83). Her own evidence was given in written form. In 1858 she was elected a member of the Statistical Society, and at the Statistical Congress of 1860 'Miss Nightingale's scheme for uniform hospital statistics' was the principal subject for discussion. Breaking her social isolation, Nightingale gave a series of breakfast parties at the Burlington Hotel during the conference. Her model statistical forms were well received and were soon adopted by the major London hospitals.

While working on the report with frenetic urgency at the Burlington, Nightingale collapsed manifesting cardiac symptoms (probably sequelae of the Crimean fever) so severe that it was thought she would die. She recovered, but remained depressed and continued to suffer from nausea, insomnia, and palpitations. The accepted medical wisdom was that excessive mental exertion on the part of a woman was unnatural and would lead to breakdown: the standard treatment was complete rest and quiet. Florence Nightingale took to her bed or couch because the doctors ordered it, but she continued to work feverishly and was hostile to anyone, including her family, who she thought did not understand her mission. This was the beginning of her twenty years of invalidism. In 1861 she had a further severe episode when she was unable to walk and suffered from alarming spondylitis.

Determined to work come what may Nightingale used her illness to free herself from family commitments, though she often used relatives ruthlessly to help with her various projects; several were coerced into acting as secretaries or guardians in the house that her father purchased for her in South Street in London's Mayfair. Here she lived with five servants, with Dr Sutherland, whom she had met in the Crimea, installed downstairs as her amanuensis to whom she fired off notes and instructions. She now astutely exploited the isolation provided by her illness to further--mostly by remorseless use of correspondence--reforms in the army, the promotion of sanitary science, the collection of statistics, the design of hospitals, and the reform of nursing and midwifery services: no Victorian, except perhaps the queen, made more effective use of attrition by letter! Not for her were the waiting in the corridors of power and the attending of committees; people came to her and by appointment.

By March 1858 Nightingale wrote a 'last letter' to Sidney Herbert excusing herself from the responsibility of the Nightingale Fund. The council, concerned that the money had been collected from the public for a specific purpose, made tentative approaches to London hospitals, but they were all wary of what they thought would be an imperium in imperio. In November Nightingale became involved in correspondence in The Builder (26 February 1859, no. 99) concerning the rebuilding of St Thomas's Hospital. The faction advocating a move to the suburbs welcomed her as an ally, and as a quid pro quo offered accommodation for a school of nursing bearing her name. Anxious about the unrest concerning the fund, Nightingale put forward a plan which was rejected by the hospital authorities, who countered with a much less ambitious plan, which, in spite of reservations by the council, she accepted as 'not the best possible but the best conceivable'. The chairman of the council, Sidney Herbert, and the secretary, Arthur Hugh Clough, Nightingale's cousin by marriage, both sick men, began negotiations, and a scheme was drawn up on scraps of paper. In June 1860 the school was opened, with fifteen probationers working as assistant nurses, six of whom were dismissed or left and one of whom died of typhus within a year. The following year both Sidney Herbert and Arthur Clough were dead: Florence Nightingale, herself ill, was devastated, and left the organization of the school to the council, with another cousin, Henry Bonham-Carter, as secretary, soon to be joined by her brother-in-law, Sir Harry Verney, as chairman.

Herbert's death robbed Nightingale of her chief contact with cabinet-level politics, and she never overcame this loss. However, another very different confidant was found in the person of Benjamin Jowett, later master of Balliol College, Oxford, with whom she came in contact through his having been given by Clough a copy of a draft of her 'Suggestions for thought to the searchers after truth among the artizans of England'. Jowett (differing from J. S. Mill) advised against publication, and the book, though set in type and bound in three volumes in 1863, was never publicly issued. He and Nightingale corresponded regularly, and met from time to time, until Jowett's death in 1893. Their first meeting occurred in 1862 when Nightingale asked Jowett to come to London to give her the sacrament, which he did (Dear Miss Nightingale, xvii). Their relationship was thus centred on religion and the discussion of religion, and was essentially epistolatory. Jowett was a bachelor, and it is not impossible that he proposed marriage to Florence Nightingale, as Cordelia Sorabji much later recalled being told by him (ibid., xxxii), but it is not probable. A marriage between two of the great Victorian manipulators-by-correspondence would certainly have been exotic; it would also have probably been unhappy. There was no need for Jowett and Nightingale to marry, for their preferred means of intercourse was already available and employed. Jowett's letters to Nightingale were edited by E. V. Quinn and John Prest (1987); her letters to him were mostly destroyed by their recipient shortly before his death.

In office
As Florence Nightingale recovered from her acute attack in 1861 she was roused to a new challenge. She had pressed Lord Palmerston, a family friend, to appoint Lord De Grey, a known reformer, as viceroy of India, and Captain Douglas Galton, a cousin by marriage, as under-secretary in charge of health and sanitation. The sanitary commission on India, which was to have been chaired by Herbert, began sitting; it reported in 1863. Nightingale gathered material for it by sending out a questionnaire to 200 stations in India (Smith, 115). Her knowledge of India became so encyclopaedic that every viceroy visited her before leaving Britain. Although she made mistakes onto which detractors fastened (ibid., 114-25), she was right about the fundamental importance of irrigation and the need for a pure water supply, and her views on famine, poverty, and debt were eminently sensible. Before the official report was completed she sent 'Instructions' about improvements to Indian barracks, but these were blocked by the India Office (ibid., 118). Her paper for the National Association for the Promotion of Social Science, 'How people may live and not die in India' (1863), was read to its meeting in Edinburgh to great acclaim. One of her advisers on India, Sir John Lawrence, became governor-general in 1863, and a new channel of influence opened, especially with respect to sanitary reform there.

During this period Nightingale was involved with the training of midwives, a subject on which she felt strongly. Part of the Nightingale Fund was used to finance an experimental training scheme at King's College Hospital, where her friend Mary Jones, under the aegis of the sisterhood of St John the Divine, was the sister superior. The scheme had only limited success and folded in 1867, not because of puerperal fever and 'her cavalier attitude to infection' (Smith, 112) but because of an acrimonious dispute between the sisterhood, the hospital authorities, and the bishop, which even Nightingale's eirenic intervention could not quell. Nevertheless, the experiment and Nightingale's 'Introductory notes on lying-in hospitals and proposals for training of midwives' laid the foundation for further schemes (Donnison, 73). Nightingale maintained that efficient nursing depended on well-designed hospitals, and, having studied hospital design all over Europe, she was quick to condemn the proposals for Netley on Southampton Water. In spite of her insistence that female nurses should be the backbone of military hospitals, and massive correspondence on the subject, the War Office remained unenthusiastic. It took another war to change this attitude.

In 1861 Nightingale was approached by William Rathbone, a philanthropist, about the possibility of supplying trained nurses for a poor-law institution in Liverpool. Few trained nurses were available at that time, but, much concerned about the fate of the sick in these institutions, in 1864 she sent Agnes Jones, who had trained at Kaiserwerth, and eight Nightingale nurses. They battled against appalling conditions and prejudice, until in 1868 Agnes Jones died of exhaustion and typhus, and this scheme came to an end. However, fired by accounts of neglect in workhouses in London, Nightingale now threw her influence behind the Association for Improving Workhouse Infirmaries, with co-workers such as J. S. Mill, Charles Dickens, and Louisa Twining, which eventually resulted in the Metropolitan Poor Law Act (1867). At the same time she persuaded the fund council to divert money for a training scheme for nurses based at the Highgate Poor Law Infirmary, and later, in 1881, more successfully, for a team of Nightingale nurses at the St Marylebone Institute, thus laying the foundation for trained nursing in the new municipal hospitals after the Local Government Act (1888).

In 1867 Nightingale wrote 'never think you have done anything effective in nursing until you have nursed, not only the poor sick in workhouses but those at home'. Again working in co-operation with William Rathbone, with whom she did not always agree, she gave urgent consideration to the need for a home-nursing scheme in London. She arranged for Florence Lees to conduct a survey to ascertain the need, which resulted in The Report of the National Association for Providing Trained Nurses for the Sick Poor. The following year, 1875, the Metropolitan and National Nursing Home was opened in Bloomsbury with Florence Lees as superintendent. Later Nightingale used her influence to ensure that the greater part of the women's jubilee offering to Queen Victoria was used to provide nursing for the sick poor at home, and the Bloomsbury Training Home became the model for the training scheme for the Queen's Institute for District Nursing.

Out of office, 1870-1880
Florence Nightingale's influence on the army and India was declining, and in 1872, when the new viceroy did not come to see her and ignored her advice, she wrote 'this year I go out of office' (Cook, 2.240). Gladstone was one of those canny enough not to be drawn into the Nightingale web, though they corresponded from time to time. Nightingale was unsympathetic to his policies, and when he did call, without an appointment, she declined to receive him. The death of her father in 1874, quickly followed by that of Mrs Bracebridge, depressed her. She returned to her youthful interest in the mystics and prepared a never-completed book on those of the middle ages. Increasingly she felt isolated and despondent. Lying in bed she wrote vast quantities of spiritual meditation. E. T. Cook, who collected these for his biography, commented on them: 'The notes are often heart-rending in their impression of loneliness, of craving for sympathy which she could not find, of bitter self-reproach' (ibid.). She was not, however, wholly inactive, and she turned her attention to the school that bore her name, the Nightingale School attached to St Thomas's Hospital in London. In spite of publicity there had been few suitable candidates, and the attrition rate was 40 per cent. She now realized that the agreement with St Thomas's had been one-sided, and she complained that the Nightingale probationers were doing half the hospital's work. After legal advice, consideration was given to spending capital and starting elsewhere. Eventually the council settled for a series of compromises, which never satisfied Nightingale and which failed to answer the fundamental questions: how should nurses be prepared to meet the health needs of the population, who should train and educate them, and how should they be tested (Baly, preface)? It is a paradox that Florence Nightingale should be best known for what she failed to achieve: a credible training for nurses in the school to which her name was given (As Miss Nightingale Said, preface).

Old age, 1880-1910
At the age of sixty Florence Nightingale considered herself old. Her friends and collaborators were dead, but her health improved. The thin, waspish woman who sent mordant, aphoristic letters to ministers now metamorphosed into a stout, benevolent old lady. She tried to keep up with public-health matters but she was increasingly out of touch. In 1888 St Thomas's appointed a matron without consulting her or the council. She continued to write sentimental addresses to probationers until 1889, but by now her eyesight was failing. After the death of her sister in 1890 she found something of a new life at Claydon House, near Bicester, where she cared for the estate and her brother-in-law (Claydon, now owned by the National Trust, houses her large bed and various memorabilia), but her last visit there was in 1894-5. She spent almost the whole of her final fifteen years in her room in South Street, London. Although from 1902 she could write only with great difficulty and her memory was failing, it was only in 1906 that the India Office was asked to stop sending her relevant papers on sanitation. She was the recipient of many honours, including membership of the German order of the cross of merit and the French Secours aux blessés militaires. In 1907 the king made her a member of the Order of Merit, the first woman to be so honoured, and this encouraged something of a revival of interest. In 1908 she received the freedom of the City of London.

Portraits are of particular importance in the life of a publicly well-known recluse. They are listed as appendix C in Cook's biography. Nightingale generally refused to sit, and disliked being photographed. Even so, Cook lists twenty-four likenesses that are 'authentic', and the National Portrait Gallery has a useful collection of photographs of her. Especially important among her images is Jerry Barrett's oil, now in the National Portrait Gallery; it was engraved by S. Bellin as Florence Nightingale at Scutari, a Mission of Mercy (1856). Barrett travelled to Scutari to paint her; she refused to sit, but gave ample opportunity for him to observe her (Smith, 85). In the 1980s the portrait was reproduced on British £10 notes. The Illustrated London News published a woodcut of Nightingale with a lamp in the Scutari hospital (24 February 1855). A photograph by the London Stereoscopic Company, taken at the request of the queen in 1856, was much reproduced. A fine bust by Sir John Steell (1859) was made for the Royal United Service Institution (now in the National Army Museum). G. F. Watts began a portrait in 1864 that he was unable to finish; Sir William Blake Richmond's oil portrait (1887, but begun earlier) established the icon of the later Nightingale, uncannily like that of Queen Victoria.

Florence Nightingale outlasted her early Victorian colleagues, and was the chief living link with those days of sanitary reform and the start of the assertion by women of a claim to a recognized, official, professional role in the central actions of national life. She died in her sleep in her room at 10 South Street, Park Lane, London, on 13 August 1910. An offer of burial in Westminster Abbey was declined by her relatives, and she was buried next to her father and mother in the churchyard of East Wellow, Hampshire, the coffin borne to the grave by sergeants drawn from the regiments of the guards. Memorial services were held in St Paul's Cathedral on 20 August, in Liverpool Cathedral, and in many other places of worship.

Religion and attitude to women
Florence Nightingale's attitude to health and the deprived must be seen in the light of her own idiosyncratic theology. Brought up by parents basically Unitarian, exposed to the philosophy of the Enlightenment, biblical criticism, and new scientific theories, like a number of her contemporaries she heard Matthew Arnold's 'melancholy, long, withdrawing roar' (M. Arnold, 'Dover Beach') of the sea of faith. Aware of her own spiritual need she sought guidance from different mentors, and at the age of thirty-two tried to set out her own philosophy in 'Suggestions for thought', dedicated to 'The Artizans of England--Seekers after Truth', whom she thought had been led astray by the teachings of the positivists. Volumes 1 and 3 are devoted to explaining God's will and God's law, and have Unitarian undertones. A disciple of the teaching of Jacques Quetelet, she believed there was a causal explanation for all human behaviour, and if the cause was corrected behaviour would improve; this argument, she thought, could be applied to health. If the factors causing ill health were removed mankind would become healthy, and the key to this lay in sanitary science. In an involved exegesis she linked this with God's will, which was that mankind must help mankind: as an example men should not pray to be delivered from cholera but bend their efforts to supplying clean water and proper sanitation. She looked to the day when sanitary science would overcome ill health and when hospitals, which she regarded as an 'intermediate state of civilization', would be abolished. It was for this reason that she continued to disregard the germ theory of infection: she thought it would lead people into ignoring the need for hygiene and sanitation. Influenced by Spinoza, she argued that God's laws were unalterable and therefore miracles were impossible. God's law was manifest in nature, and it is noticeable that in her best-selling book Notes on Nursing (1860) she referred to disease as being 'a reparative process which Nature has instituted'. It was the duty of the nurse to put the patient in a position for nature to act on him; the nurse was thus aiding God's law, hence the emphasis on fresh air and the design of the Nightingale wards.

Volume 2 of Nightingale's 'Suggestions' is a diatribe about the wrongs suffered by women and is out of place in a metaphysical disquisition. Virginia Woolf in A Room of One's Own (1929) referred to it as 'Shrieking aloud in agony' (p. 47). Florence Nightingale's attitude to women was contradictory. She considered them selfish, and, though she adulated a chosen few, she preferred working with men. She was an early campaigner for women's rights, particularly their right to property, and she inveighed against the limitations imposed on educated women undertaking worthwhile and paid work. However, in her later years she was irritated by women clamouring to enter male preserves like medicine, maintaining that there was plenty to be done in women's work like midwifery, teaching, and nursing. She made no common cause with women claiming the right to train as physicians. She argued against J. S. Mill that the lack of a vote was the least of women's disabilities. Her attitude to women was patrician, though at the end of her life she accepted that she had not taken sufficient account of 'ordinary women'. In fact she was a child of her time, and she lived for ninety years: the enthusiasms of radical youth were replaced by a more reactionary old age.

At her death Nightingale's papers passed to her executor, Henry Bonham-Carter, who authorized Sir Edward Tyas Cook to write an official biography. Cook's two-volume Life of Florence Nightingale was published in 1913, and is an exceptionally well-researched example of its genre; it is also both sympathetic and critical, and remains a valuable biography as well as being an archival quarry. In 1918 Lytton Strachey included a short memoir of Nightingale in his Eminent Victorians. Influenced by Freud he moved away from investigation into the realms of psychotherapy and fictionalization, claiming that the real Florence Nightingale was 'more interesting than the legendary one though less agreeable'. While highlighting the harsh aspects of her life Strachey did not deny her achievements.

Early nursing historians were the most ardent keepers of the Nightingale flame (for example, M. A. Nutting and L. L. Dock, A History of Nursing, 1907). Anxious to portray nursing as an educated and homogeneous profession they overstated the failures of nursing pre-1860 and exaggerated the transformation. Nightingale was the ideal icon for publicity--educated, impeccably respectable, and a national heroine; her lamp became the symbol of nursing. Anna Neagle thus portrayed her in Herbert Wilcox's film The Lady with a Lamp (1951), though with a few Stracheyesque additions. Because Cook's biography was so monumental, and because of the sheer volume of material scattered in collections and libraries, most subsequent biographies were a recension of it. In 1950 Cecil Woodham-Smith produced a popular biography in which she claimed to have had access to new material. However, it added little to the life by Cook and errors and misconceptions remained.

Since 1950 there has been an upsurge of interest in this enigmatic woman who is a Victorian figure but, on the other hand, strangely contemporary. The medical profession has attempted to explain her invalidism and various diagnoses have been expounded, including the theory that it was psychosomatic (Pickering), and theologians have examined her spirituality and its effect on her work. Research on the Nightingale Fund papers shows there was no sudden reform in nursing: it was a slow, inevitable process due to a multiplicity of factors, and, as Monica Baly has argued, the so-called Nightingale legacy was a mixed blessing. Other historians have taken an iconoclastic approach. Barry Smith's striking study (1982) stripped away the iconic aspects of the Nightingale legend to examine the remarkable network of manipulation (mostly by letter) by which she sought to impose her will and achieve her objectives.

Florence Nightingale remains an enigmatic figure. Her sense of being 'in office' and 'out of office' reflects the frustration of a woman who sensed power but who, in the circumstances of the time, could use it only obliquely, and then chiefly by persuading men to act for her. Her remarkable practical ability, her intense religiosity, her illnesses, and her image of herself as a medieval recluse in a modern age reflect a complex character whose complexity grows with time and with the changing role of women in public life.


E. T. Cook, The life of Florence Nightingale, 2 vols. (1913)
C. Woodham-Smith, Florence Nightingale, 1820-1910 (1950)
M. A. Nutting and L. L. Dock, A history of nursing: the evolution of nursing systems from the earliest times to the foundation of the first English and American training schools for nurses (1907)
L. Strachey, Eminent Victorians (1948)
'Ever yours, Florence Nightingale', ed. M. Vicinus and B. Negaard (1989)
R. Van der Peet, The Nightingale model of nursing (1995)
A. Summers, Citizens and angels (1988)
J. Donnison, Midwives and medical men: a history of inter-professional rivalries and women's rights (1977)
R. S. Hodgkinson, The origins of the national health service: the medical services of the new poor law, 1834-1871 (1967)
G. Pickering, The creative malady (1974)
F. B. Smith, Florence Nightingale: reputation and power (1982)
M. E. Baly, Florence Nightingale and the nursing legacy (1986); 2nd edn (1997)
As Miss Nightingale said ...: Florence Nightingale through her sayings, ed. M. E. Baly, 2nd edn (1997)
W. J. Bishop and S. Goldie, A bio-bibliography of Florence Nightingale (1962)
A calendar of the letters of Florence Nightingale, ed. S. Goldie (1983) [microfiche; with introduction by S. Goldie]
b. cert.
CGPLA Eng. & Wales (1910)
Dear Miss Nightingale: a selection of Benjamin Jowett's letters to Florence Nightingale, 1860-1893, ed. E. V. Quinn and J. Prest (1987)

Anglesey County RO, Llangefni, letters
BL, corresp. and papers, Add. MSS 43393-43403, 45750-45859, 46123, 46176, 46385, 47714-47767, 49623, 52427, 59786, 68882-68890
BL, letters, RP 2027-2028 [copies]
Bucks. RLSS, letters relating to Royal Buckinghamshire Hospital
Claydon House, Buckinghamshire, corresp. and papers; diary
LMA, corresp. and papers
University of British Columbia, Woodward Biomedical Library, corresp.
University of Kansas Medical Center, Kansas City, Clendening History of Medicine Library and Museum, letters
Wellcome L., corresp. relating to Crimea, etc.
Wellcome L., letters
Women's Library, London, papers |  Balliol Oxf., letters to Sir Louis Mallet
BL, letters to T. G. Balfour, Add. MS 50134
BL, corresp. with W. E. Gladstone, Add. MSS 44397-44488, passim
BL, corresp. with Sir J. Hall, Add. MS 39867
BL, corresp. with Lord Ripon, Add. MS 43456
BL, corresp. with Verney family, Add. MSS 68882-68890
BL OIOC, letters to Sir Mountstuart Grant-Duff, MS Eur. F 234
BL OIOC, letters to William Rowntrie Robertson
Bodl. Oxf., corresp. with H. W. Acland
Bodl. Oxf., corresp. with Doyle family
British Red Cross Museum and Archives, London, corresp. with Sir Robert Loyd-Lindsay
CUL, corresp. with Lord Mayo
Derbys. RO, letters to C. B. N. Dunn
Emory University, Atlanta, Georgia, Pitts Theology Library, corresp. with H. E. Manning
Hants. RO, letters to Bonham-Carter family
Leics. RO, corresp. with Martin family
LMA, corresp. with Henry Bonham-Carter and others on business of Nightingale Fund, with papers
Lpool RO, corresp. with William Rathbone
NA Scot., letters to Lord Panmure
NAM, corresp. with Lord Raglan
NL Ire., letters to Sir Ranald Martin
NRA, priv. coll., letters to Lord Wemyss
Royal British Nurses' Association, London, corresp. with William Clark [copies]
Royal London Hospital Archives and Museum, corresp. with Eva Luckes
St Thomas's Hospital, London, corresp. with William Smith
Trinity Cam., letters to Lord Houghton
U. Newcastle, Robinson L., letters to Sir Charles Trevelyan
U. Nott. L., letters to duke of Newcastle
U. Wales, Bangor, letters to William Rathbone relating to Bangor typhoid epidemic of 1882
UCL, corresp. with Sir Edwin Chadwick
UCL, corresp. with Karl Pearson
W. Yorks. AS, Leeds, letters to Lady Canning
Wellcome L., letters to Sir William Aitken
Wellcome L., letters to G. H. De'ath
Wellcome L., letters to William Farr
Wellcome L., letters to Louisa Gordon
Wellcome L., letters to Mrs T. H. Green
Wellcome L., letters to Amy Hughes
Wellcome L., letters to Sir John Lefroy
Wellcome L., corresp. with Sir Thomas Longmore
Wellcome L., letters to Charles Plowden
Wilts. & Swindon RO, corresp. with Lord Pembroke  SOUND  BL NSA, recorded talks

W. White, watercolour drawing, c.1836 (with her sister), NPG
J. Barrett, watercolour study, 1846, NPG
Elizabeth, Lady Eastlake, pencil drawing, 1846, NPG
R. J. Lane, chromolithograph, pubd 1854 (after H. Bonham-Carter), BM, NPG
F. Holl, lithograph, pubd 1855 (after P. N.), NPG
J. Barrett, group portrait, oils, 1856?, NPG; study, NPG
H. Bonham-Carter, plaster statuette, c.1856, St Thomas's Hospital, London
Goodman, albumen print, c.1857, NPG [see illus.]
Scharf, pencil drawing, 1857, NPG
Goodman, photograph, 1858, Claydon House, Buckinghamshire
H. Hering, photograph, c.1858, repro. in Cook, Life
J. Steell, marble bust, 1859, NAM; repro. in Cook, Life
J. Steell, bust, 1862, Derby Art Gallery; bronze cast, NPG
W. B. Richmond, oils, 1887, Claydon House, Buckinghamshire
S. G. Payne & Son, photograph, 1891, repro. in Cook, Life
E. Bosanquet, photograph, 1906, repro. in Cook, Life
F. A. de Biden Footner, watercolour, 1907, repro. in Cook, Life
Feodora, Countess von Gleichen, chalks, 1908, Royal Collection
A. G. Walker, statue, 1915, Waterloo Place, London
J. Barrett, oils, NPG
probably J. Barrett, three pencil and watercolour sketches, NPG
F. A. de Biden Footner, pencil with watercolour drawing, repro. in Cook, Life
H. Bonham-Carter, pencil drawing (aged about twenty-five), repro. in Cook, Life
A. E. Chalon, drawing (as child), Claydon House, Buckinghamshire
Feodora, Countess von Gleichen, statue, London Road, Derby
C. H. Jeens, stipple (after statue by H. Bonham-Carter), BM; vignette on title to C. Yonge's Book of golden deeds (1864)
Pinches, medal, NPG
W. Simpson, drawing, repro. in W. Simpson, The seat of war in the East, 2nd ser. (1856)
cartes-de-visite, NPG
photogravure, NPG; repro. in The Sphere (20 Aug 1910)
relief tablet, St Paul's Cathedral, London
wood-engraving, NPG; repro. in ILN (24 Feb 1855)

Wealth at death  
£36,127 16s. 8d.: probate, 31 Oct 1910, CGPLA Eng. & Wales

Oxford University Press 2004 All rights reserved


GO TO THE OUP ARTICLE (Sign-in required)