Chapter 4
The State of Hospitals and Nursing
The Nightingales' horror at Florence's nursing ambitions was unsurprising. In 1845, hospitals were places of wretchedness, degradation, and squalor. "Hospital smell" from dirt and poor sanitation was so overpowering that visitors were often seized with nausea upon entering. Wards were gloomy spaces crammed with fifty or sixty beds less than two feet apart, making even basic decency impossible. Florence would later document how floors and walls became "saturated with organic matter," windows remained sealed for months in winter creating "sickening" smells and moisture that produced "minute vegetation."
Patients arrived from slum tenements and remained filthy throughout their stay, as nurses generally didn't wash patients. New patients commonly received the same unwashed sheets used by previous occupants. Gin and brandy smuggled into wards led to frightful scenes of half-dying patients attacking each other or suffering fits of "screaming horrors," sometimes requiring police intervention to restore order.
The notorious immorality of hospital nurses presented an even greater obstacle to Florence's plans. In 1845, respectable women simply did not become nurses. It was actually preferred that nurses "should be women who had lost their characters"-women who had borne illegitimate children. Nurses commonly slept in wooden cages on landing places outside wards, where "it was impossible for any woman of character to sleep." Many nurses were drunkards, with one physician stating he could trust only two nurses in his entire hospital to administer medicines properly.
Despite these obstacles, Florence's determination never wavered. She secretly obtained the Year Book of the Institution of Deaconesses at Kaiserswerth in 1846, recognizing it as a place where she could train as a nurse without the moral objections of English hospitals. "There is my home, there are my brothers and sisters all at work," she wrote privately. "There my heart is and there, I trust, will one day be my body."
After years of opposition, Florence finally reached Kaiserswerth on July 31, 1851. Though not nursing but observing, she noted the hospital was free from the "disgusting hospital smell" accepted in England as inevitable. After two weeks, she left Kaiserswerth "feeling so brave as if nothing could ever vex me again," brimming with vitality and renewed concentration. She quickly wrote a 32-page pamphlet describing Kaiserswerth as a place of work, happiness, and comradeship for England's women "going mad for want of something to do."
Chapter 5
The Crimean War and Florence's Commission
The British Army's invincibility was an article of faith, with Waterloo still a recent memory. But forty years of economy had decimated the once-great force. By 1854, artillery consisted of just forty field-pieces, many defective. The army had no reserves, and the processes for providing food, clothing, and medical care had fallen into confusion before troops even sailed.
Despite public confidence as magnificent Guards marched through London, the reality was grim. In June 1854, troops disembarked at Varna, Bulgaria, where they accomplished nothing and suffered a devastating cholera epidemic. When the army embarked from Varna to attack Russia's naval base at Sebastopol, insufficient transports meant equipment was left behind-pack animals, tents, cooking equipment, hospital marquees, medicine chests, and bedding.
A week after landing at Calamita Bay, the British and French won the hard-fought battle of Alma, but wounded soldiers paid the price for abandoned hospital equipment. Without bandages, splints, chloroform, or morphia, the wounded lay on the ground or straw mixed with manure. Amputations were performed without anesthetics, patients sitting on tubs or lying on old doors while surgeons worked by moonlight for lack of candles.
At Scutari, the wounded endured ghastly journeys across the Black Sea in "hospital ships" that were merely ordinary transports with minimal medical supplies. Upon arrival at the Barrack Hospital, they found no beds, no kitchens, and lay on the floor wrapped in blankets saturated with blood and excrement. Many lay without water for a day and night.
When William Howard Russell, The Times' war correspondent, exposed these conditions in scathing dispatches published October 9-13, national outrage erupted. Sidney Herbert, Secretary at War responsible for the treatment of wounded soldiers, found himself in a painful position. His Russian family connections made him politically vulnerable, yet he acted decisively, writing to Florence Nightingale on October 15th to lead nurses to Scutari with government sanction and funding.
Unknown to Herbert, Florence had already organized her own expedition. When Herbert's letter crossed with hers, he formally invited her to superintend the introduction of female nurses into military hospitals. The Cabinet unanimously approved her appointment on October 18th as "Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey."
The appointment caused a sensation-no woman had ever been so distinguished before. Even Parthe and Fanny, who had previously opposed her nursing ambitions, were now ecstatic. The Herberts' London house became expedition headquarters, where potential nurses were interviewed. Though they hoped for forty qualified candidates, only thirty-eight remotely suitable appeared. "As to that stuff about the 'enthusiasm' of nursing," Florence later wrote, "that is all bosh-we had scarcely one woman sent out who was even up to the level of a head nurse."
Chapter 6
The Barrack Hospital at Scutari
The Turkish Barracks on the Bosphorus appeared palatial from afar but housed horrors within. Its vast corridors stretched for four miles, with broken tiles and damp walls. The complex included troop depots, a spirits-selling canteen, cavalry stables, and cellars where 200 women lived in squalid conditions.
The hospital's fatal flaw lay in its sanitation. Most deaths resulted not from original wounds but from diseases contracted within. Statistics showed higher survival rates in makeshift field hospitals than at Scutari. In early 1855, nearly all of the 2,349 patients died - likely an undercount.
The doctors initially rejected Florence's appointment, viewing female nurses as a threat to discipline. Though they couldn't openly oppose her due to her connections, they remained hostile. Her party of forty received just six damp, flea-infested rooms. The hospital lacked basic necessities - furniture, medical supplies, and adequate water.
Florence gained her first foothold through the kitchen. Despite regulations for various diets, patients were starving. Using supplies and portable stoves from Marseilles, she established the hospital's only source of invalid food within days of arrival.
Everything changed on November 9th as casualties flooded in. The overwhelming need finally forced doctors to accept her help. Her nurses created makeshift bedding from straw-filled sacks until even these ran out. Men lay on bare boards in vermin-infested conditions, with severely inadequate sanitary facilities. The stench of backed-up sewage permeated beyond the walls.
On November 14th, a devastating hurricane struck the Crimea, destroying tents, field hospitals, and the ship Prince carrying winter supplies. As winter set in with sleet and harsh winds, diseases spread rapidly among the exposed troops. The combination of weather and unsanitary conditions created a perfect storm of suffering.
Chapter 7
Florence Becomes Supreme
Amid the crisis, Florence Nightingale became the rock to which everyone clung. Even the Purveyors-"veterans of the Spanish War"-came to her "trembling under responsibility and afraid of informality." Her calmness, resource, and decisive action elevated her to goddess-like status. The soldiers adored her, saying, "If she were at our head, we should be in Sebastopol next week." Doctors grew completely dependent on her, with Colonel Sterling reporting home: "Miss Nightingale now queens it with absolute power."
With over 30,000 at her disposal, including 7,000 she had personally collected, Florence became the solution to Scutari's supply crisis. Constantinople was a major world market, and word spread that for anything from milk puddings to water-beds, one should "go to Miss Nightingale." She recruited Mr. Macdonald of The Times, Sidney Godolphin Osborne, and Mr. Augustus Stafford as her staff. Macdonald became her chief-of-staff, purchasing needed supplies in Constantinople which she then issued through proper requisition channels.
Florence's influence over the men was extraordinary. She could make soldiers stop drinking, write home to their wives, and submit to painful procedures. The troops worshipped her, finding comfort even in seeing her pass by. One soldier wrote they would "kiss her shadow as it fell and lay our heads on the pillow again content." For her sake, the soldiers gave up their habitual bad language. She later wrote movingly about their "innate dignity, gentleness and chivalry" that prevented "the use of one expression which could distress a gentlewoman" even amidst scenes of loathsome disease and death.
Despite her administrative victories, Florence's greatest difficulties came from her own nurses. Petty complaints about uniform caps arose amid horrific conditions-"We are steeped up to our necks in blood," she wrote. While some nurses like Mrs. Roberts from St. Thomas's and Mrs. Drake from St. John's House were "treasures," many others required constant supervision. Convincing them of the necessity for discipline proved nearly impossible, with many resenting Florence's insistence on doctor's orders before distributing food or medicine.
By December's end, hospital administration had collapsed completely. When Mr. Stafford offered to personally pay for cleaning the filthy lavatories, Major Sillery refused, fearing he had no authority to approve such work without proper instructions. In this administrative paralysis, officials gradually realized there was one person at Scutari who had both money and authority to act: Miss Nightingale.
Chapter 8
A National Heroine
While Florence struggled in the Crimea, a powerful legend was growing in England as survivors of the British Army returned home telling stories of Miss Nightingale and the Barrack Hospital. This legend belonged especially to the poor and illiterate whose sons she had treated with dignity. Popular songs about her circulated, with titles like "The Nightingale in the East" and "God Bless Miss Nightingale." Penny biographies sold widely, and Staffordshire figures depicting her became popular.
On November 29th, 1855, a public meeting was held at Willis's Rooms to recognize her services, with the Duke of Cambridge as chairman. The overwhelming public response led to the establishment of the Nightingale Fund to create an institute for training nurses. Queen Victoria presented her with a specially designed brooch as "a mark of the high approbation of your Sovereign." Florence herself was unmoved by the praise and popularity, writing to Parthe that she felt "painfully the eclat which has been given to this adventure of mine," believing it had harmed their work.
As Florence prepared to return to England, the nation eagerly anticipated honoring her as the only great reputation to emerge from the war. The Government offered a man-of-war to transport her home in state. Parthe wrote that entire regiments wished to meet her or send bands "to play her home wherever she might arrive, by day or nighte." Mayors of Folkestone and Dover sought to discover where she would first touch English ground "to rouse the whole community," while committees planned triumphal arches, processions, and parish addresses.
Florence rejected everything. Bereaved and haunted by memories of her "poor men" left in Crimean graves, she traveled incognito from Constantinople to Marseilles as "Miss Smith" with Aunt Mai. After a brief stop in Paris, she arrived in England alone, first visiting the Bermondsey Nuns for prayer and meditation before walking unannounced up the drive to Lea Hurst, where the housekeeper shrieked with joy upon recognizing her.
Two heroic figures emerged from the Crimea-the soldier and the nurse-both transformed in public estimation through Florence's influence. The British soldier was no longer seen as a drunken brute but as a symbol of courage, loyalty, and endurance. Similarly, Florence had stamped the nursing profession with her own image, replacing previous stereotypes of tipsy, promiscuous women with her vision of nurses as strong, controlled, and selfless professionals superior to considerations of class or sex.
Chapter 9
The Call to Reform
Florence returned from the Crimea haunted not by ghosts but by facts-the preventable deaths of thousands of soldiers from disease. She realized the mortality rate of 73 percent in six months was not the result of war but of the system controlling the health administration of the British Army-a system still in operation murdering men daily in barracks and hospitals across Britain. The Crimean tragedy demanded reform, not revenge.
Florence recoiled at first from her calling. Must she renounce human contact and the physical tending of the sick for the aridity of official correspondence, statistics, and regulations? After midnight agonies, tears, and prayers, she submitted to the summons, writing: "I stand at the altar of the murdered men, and while I live I fight their cause." But her transformation came at a cost-the benevolence and patience of her youth faded as she grew increasingly isolated, confiding in no one and explaining nothing to bewildered family and friends.
Florence faced enormous challenges in initiating army reform. Being both a woman and a popular heroine made her doubly suspect to officials who detested her. She deliberately destroyed her fame as a matter of policy, refusing all public appearances, interviews, and honors despite extraordinary public adoration. When an unexpected opportunity arose through Sir James Clark to meet with Queen Victoria at Balmoral, Florence seized it to prepare a comprehensive case for army reform, requesting a Royal Commission to examine military hospitals and the Army Medical Department.
Despite her weakened physical condition, she worked tirelessly in Edinburgh with Colonel Tulloch and Sir John McNeill, compiling statistics and facts from their inquiry while also inspecting barracks and hospitals. Her meetings with Queen Victoria and Prince Albert proved tremendously successful-the royal couple was deeply impressed by her clear intellect and modest manner.
The critical challenge remained convincing Lord Panmure, the Secretary of State for War-a notorious procrastinator nicknamed "the Bison" who hated details and resisted change. Despite Sidney Herbert's pessimism, Florence charmed Panmure completely during their October meeting. She secured his agreement for a Royal Commission with instructions according to her suggestions, and his invitation to review plans for Netley Hospital. With Sidney Herbert reluctantly agreeing to chair the Commission, Florence carefully selected commissioners including Dr. Farr for statistics and Dr. Alexander, "unquestionably the ablest man in the British Medical service."
Chapter 10
The Burden of Reform
The strain on Florence was enormous. Three months earlier she had been an invalid; now she worked night and day on the Commission while simultaneously transforming her Confidential Report into a comprehensive work on army medical administration. This would become her "Notes on Matters affecting the Health, Efficiency and Hospital Administration of the British Army"-nearly 1000 closely printed pages of figures, facts, tables, and statistical comparisons.
Florence's work was intensified by the petty irritations and emotional conflicts of family life. In November 1856, Fanny and Parthe moved to the Burlington Hotel, extracting full enjoyment from their position as mother and sister of Miss Florence Nightingale. They were stopped by strangers inquiring after Florence, received admiring letters, and struck dramatic poses-Parthe christened Aunt Mai "My Scutari Aunt" and assumed the role of guardian of her sister's shrine, declaring "I cannot believe she will live long" and "she is so calm, so holy."
Despite their profuse expressions of affection, they behaved with total lack of consideration. Florence could only work in a small inner drawing-room while they entertained friends in the adjoining room, interrupting her constantly. They kept the family carriage for themselves, forcing Florence to use cabs or public omnibuses despite her exhaustion. She maintained a punishing schedule-inspecting hospitals at Chatham one day, visiting St. Mary's Paddington and Bermondsey the next, then working through the night with Dr. Sutherland and Dr. Farr.
Florence's most sensational disclosure came from comparing mortality rates. She proved that living conditions in British Army barracks during peacetime were so appalling that soldier mortality was double or more than the civilian rate. In the parish of St. Pancras, the civil mortality rate was 2.2 per 1000, while in the Life Guards barracks there, it was 10.4. In Kensington, civilians died at a rate of 3.3, while soldiers in Knightsbridge barracks died at 17.5 per 1000. In her powerful phrase that became the Reformers' battle cry, she declared: "Our soldiers enlist to death in the barracks."
By August 1857, Florence's health finally collapsed under the strain. Having eaten no solid food for four weeks, living on tea, she suddenly broke down, telling Parthe, "I must be alone, quite alone. I haven't been alone for 4 years." She refused family nursing and went to Malvern for treatment, taking only a footman. Her condition was so grave that Harriet Martineau updated her obituary notice for the Daily News.
Though desperately ill, Florence continued working from her sickbed. Dr. Sutherland implored her to rest, writing that "women can do what men could not do, and women will dare suffering knowingly where men would shrink." But she responded with impatience, ordering him to Malvern to continue preparations for the sub-Commissions. Even at death's door, she insisted the work must continue.
Chapter 11
A Quieter Life
Florence found herself changing. "I assure you I don't let these things corrode into me now," she told Clarkey in 1868. Her collapse in December 1867 had weakened her not only physically but mentally. Concentration became difficult, and some of her fierce energy had dissipated. "I am becoming quite a tame beast-fit for a lady to ride or drive-as horse dealers say of their most vicious brutes," she wrote to M. Mohl.
In the summer of 1868, she visited Lea Hurst for three months-her first time there since 1856. This marked a significant change in her way of life. In 1869, she spent three months with her parents at Embley, followed by a month at Embley and three months at Lea Hurst in both 1870 and 1871. By 1872, she was spending eight months at Embley.
At Lea Hurst, she read Jane Austen, whom she ranked "second to Shakespeare in the English language for dramatic power," and Shakespeare himself-"I don't know whether Hamlet was mad, he would certainly have driven me mad." Jowett spent a week with her there, though she insisted Parthe stay away. Mother, now eighty, was "more cheerful, more gentle than I ever remember her though of course much aged. Her memory is nearly gone but to me she is far dearer, far more respectable than ever before." Father was seventy-four.
By September's end, she was bored with family life. Books and friends were not sufficient-she needed an outlet. Jowett had been urging her to write, hoping she'd abandon a life "dependent on temples of friendships and the good will of the Minister." In summer 1868, she resolved to devote an hour daily to writing, beginning a "Treatise on the Reform of the Poor Law" at his suggestion.
In 1870, some urgency of old days returned when war broke out between Germany and France. The "National Society for Aid to the Sick and Wounded" (later the British Red Cross) was founded in July, and Florence was pressed to abandon all other work to take control. Despite Parthe's pleas to devote her talents to wounded soldiers once more, she refused. She had chosen organizational realism over self-sacrificial romanticism and wouldn't turn back. Her Indian work affected millions and took precedence over European war hospitals.
Nevertheless, it proved impossible to be Florence Nightingale and remain uninvolved. People worldwide assumed she was nursing in Red Cross hospitals. She wrote an appeal for funds read at the Society's first meeting, and contributions addressed to her personally demonstrated her enduring hold on people's hearts sixteen years after Scutari. Donations came "from poor congregations of all kinds, from Negroes in the West Indies, from Ragged Schools, National Schools, Factories-not the rich and comfortable but the whole mass of hard working honest frugal stupid people."
Chapter 12
Freedom and Reconciliation
On February 2nd, 1880, Fanny died peacefully at ninety-two, after regaining consciousness to listen to her favorite hymns. The conflict that had embittered Florence's life for forty years was over. At sixty, she was free-not because Fanny was dead, but because she had become reconciled with both Fanny and Parthe. The resentment that had poisoned her melted away before their childishness, helplessness, and suffering.
A change came over Florence. The bonte, the pervading benevolence of her youth, returned. She became gentler, calmer, even tolerant. When Uncle Sam died in 1881, she reconciled with Aunt Mai. She found herself able to be sympathetic to Mr. Gladstone. With Parthe, for the first time since childhood, she became intimate, visiting Claydon where "Miss Nightingale's room" was set aside for her. As Parthe's illness increased, Sir Harry leaned on her; she participated in his sons' lives and helped manage his affairs. "You are our Family Solicitor," he wrote, "to whom we all turn when we get into a scrape."
Failure began to weigh less heavily. Jowett reminded her of her accomplishments: "Nobody knows how many lives are saved by your nurses in hospitals... how many thousand soldiers... how many natives of India (counted probably by hundreds of thousands) preserved from famine, oppression and debt by the energy of a sick lady who can scarcely rise from her bed." Could he be right? She had never wanted ordinary happiness-seeing Lord Stanley years later, "so complacent, so obese, so happy," she thought, "O happiness, like the Bread Fruit Tree, what a corrupter of human nature thou art!"
Yet now she could look forward with hope. "I cannot remember the time when I have not longed for death," she wrote to Clarkey in June 1881. "After Sidney Herbert's death and Clough's death in 1861, for years I watched for death as no sick man ever watched for the morning. It is strange that now I am bereft of all, I crave for it less. I want to do a little work, a little better, before I die."
And opportunity was coming. After Fanny's death, she briefly collapsed, spending time at Ramsgate and Seaton against doctor's orders. But the Liberal triumph in the April 1880 election transformed the political scene. Sir Harry was elected at seventy-eight, Mr. Gladstone became Prime Minister, and her old friend Lord Ripon was appointed Viceroy of India. Official doors opened to her again.
Chapter 13
If Life Had Used Her Hardly
Few human beings have enjoyed a fuller, happier old age than Florence. She was treated with almost religious deference-ministers, kings, princesses, and statesmen waited at her door, her utterances respected as an oracle. To millions of women worldwide, she became the symbol of new hope, the sign of a new age.
Though she never married, she enjoyed the pleasures of matriarchy. In the lives of a large circle of young people-Shore's daughters and sons, Clough's children, and Parthe's stepchildren-she held the place of a powerful, generous, and respected grandmother.
In old age, an extraordinary atmosphere of peace flowed from her. She remained formidable, preserving her rule of seeing only one person at a time and bending her whole attention on each visitor, but she was animated by the purest benevolence. To confide in her became irresistible. She delighted in the small crises of daily life-Clough's son brought his love affairs, Shore's daughters their examination papers. No detail was too small-a servant's character, the quality of meat, treating a cold. She wrote birthday letters and sent gifts to everyone from family members to her butcher and the policemen at the Park gates.
Slowly, inexorably, the curtain descended. Blind and with failing memory, she no longer recognized visitors, mistaking them for friends of her youth, asking for Sir Harry Verney who had been dead for twelve years. Hour after hour she lay inert, unconscious, her still-pretty hands folded peacefully outside the bedclothes. Words no longer reached her, though when young relatives sang hymns she seemed to recognize familiar tunes.
And now, when she had passed beyond the power of the world to please or pain, a shower of honors fell upon her. In November 1907, King Edward VII bestowed the Order of Merit-the first woman ever to receive it. Since no ceremony was possible, the Order was left at South Street by the King's representative. It was uncertain if she understood the honor. "Too kind, too kind," she murmured. The following year she received the Freedom of the City of London, but when the Roll of Honor was brought to her bedside and her hand guided to sign two wavering initials "F.N.," she evidently did not understand what she was signing.
The end came on August 13th, 1910, when she fell asleep about noon and did not wake again. In deference to her wishes, the offer of a national funeral and burial in Westminster Abbey was declined. She was buried in the family grave at East Wellow, her coffin carried by six sergeants of the British Army. Her only memorial is two lines on the family tombstone, "F.N. Born 1820. Died 1910." She had lived for ninety years and three months.
