The Victorian Era

How Did Florence Nightingale Change Nursing

Article · Science & Invention · The Victorian Era, 1837–1901

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Florence Nightingale is the single most famous figure in the history of nursing, and her influence on the profession of the Victorian nurse and on the broader reform of Victorian Medicine and Public Health was profound and lasting. Nightingale did not invent nursing, which had existed for centuries in religious orders, in workhouse infirmaries, and in domestic service, but she raised the standing of the nurse, established nursing as a profession, founded the first secular nursing school in the world at St Thomas’ Hospital in London in 1860, and used her skills as a statistician and a public campaigner to reform the army medical service and the broader public health of the British nation. The story of Nightingale is part of the wider history of Victorian Science, Invention, and Technology, and it is closely connected to the history of How did germ theory change medicine? and to the What was the Great Stink of London?.

The Making of a Reformer

Florence Nightingale was born in 1820 into a wealthy, well-connected English family. Her father, William Edward Nightingale, was a landowner and a member of Parliament, and her mother, Frances Smith, was a socialite. The family travelled widely on the Continent, and Florence received an unusually broad education for a woman of her class, studying mathematics, science, languages, and philosophy. From an early age, she felt a religious calling to nursing, which she recorded in a diary entry of 7 February 1837 as a call from God. Her family, however, considered nursing to be a menial occupation unsuitable for a woman of her class, and it was not until 1851 that she was able to undertake a brief period of training at the Institution of Protestant Deaconesses at Kaiserswerth in Germany, an experience that convinced her of the need for trained, professional nurses in England.

In 1853, Nightingale took a post as superintendent of the Establishment for Gentlewomen during Illness, a small private nursing home in Harley Street, London. She quickly earned a reputation as a brilliant organiser, and when the Crimean War broke out in 1854 she was recruited by Sidney Herbert, the Secretary at War, to lead a party of nurses to the military hospital at Scutari, near Constantinople. The conditions she found there were horrific. The hospital was housed in a former Turkish barracks that had been built on a clogged sewer, the mortality rate was over 40 per cent, and the medical officers of the army were hostile to the new nurses. The story of the Crimean War is part of the wider Victorian Political History, and the Scutari hospital became a byword for the failure of the army medical service.

Scutari and the Crimean War

Nightingale arrived at Scutari in November 1854 with 38 nurses, mostly Anglican religious sisters, and she set about reforming the hospital from the moment of her arrival. She organised the laundering of the patients’ clothes, the cleaning of the wards, the establishment of a proper kitchen, and the introduction of basic sanitation measures. The mortality rate fell dramatically, although the reasons for the fall are debated: the introduction of a proper sewer, the better nursing, and the reduction in the severity of the cases all played a part. The legend of the lady with the lamp, Nightingale walking the wards at night with her Turkish lamp, dates from this period, and the Victorian Literature, Theatre, and the Written Word of the day was quick to mythologise her work.

Nightingale used the Crimean War to campaign for reform of the army medical service. She collected and published a long series of statistics on the causes of mortality among the soldiers, and her famous polar area diagram of 1858, sometimes called the rose diagram, used the new graphical methods of statistics to demonstrate that more soldiers died of disease than of wounds in the Crimean War. The diagram was a powerful tool in the campaign, and it is a landmark in the history of the visual presentation of data. Nightingale’s work in the Crimea helped to bring about the establishment of a Royal Commission on the Health of the Army in 1857, the formation of the Army Medical School at Netley in 1860, and the eventual reform of the War Office. The story of the reforms of the Victorian Economy and Industrialization cannot be told without Nightingale.

The Founding of Modern Nursing

In 1860, Nightingale used a fund of £45,000 raised by public subscription after the Crimean War to found the Nightingale Training School for Nurses at St Thomas’ Hospital, London. The school was the first secular training school for nurses in the world, and it established the principles of nursing education that would be copied across the world: a year of training, a uniform, a code of conduct, and a connection to a religious order. The school trained nurses for the London hospitals, the workhouse infirmaries, the Victorian Workhouses, the army and navy, and the British Empire in the Victorian Era. The graduates of the school went on to found the first training schools in Australia, Canada, the United States, and India, and the Nightingale model of nursing education became the international standard.

Nightingale’s school was part of a wider reform of the hospital system in the late Victorian period. The hospitals of London, Edinburgh, and Dublin were reorganised on the basis of the new How did germ theory change medicine?, the training of the nurse, and the principle that the hospital was a place of cure rather than of charity. The Victorian Architecture and Interior Design of the period included the great new hospitals, the new workhouse infirmaries, and the new fever hospitals, and the architecture of the hospital was a reflection of the new nursing.

Nightingale as a Public Health Campaigner

Nightingale was not only a reformer of nursing; she was also a public health campaigner, and she used her influence in the army, in the government, and in the royal family to push for sanitary reform. She campaigned for the reform of the How was the London sewer system built?, for the improvement of the What was the Great Stink of London?, and for the establishment of the new public health legislation of the 1870s. She corresponded with the leading sanitary reformers of the day, including Edwin Chadwick, John Simon, and William Farr, and she used her statistical skills to support their work. Nightingale is sometimes called the founder of medical statistics, and her work in this field shaped the sanitary reform of the later Victorian period.

Nightingale’s influence on the Victorian Morality and Social Reform of the period was also significant. She used her status as a national heroine to campaign for the reform of the army, the reform of the hospitals, the reform of the workhouse, and the reform of the public health system. She was an advocate for the education of women, and she corresponded with many of the leading women reformers of the day, including Elizabeth Garrett, the first English woman to qualify as a doctor, and Josephine Butler, the campaigner against the Contagious Diseases Acts.

Conclusion

Florence Nightingale transformed nursing from a menial occupation, often associated with drunkenness and sexual impropriety in the early Victorian period, into a respectable profession for women of the middle class. She founded the first secular training school for nurses, she campaigned for sanitary reform, she used her statistical skills to support her arguments, and she became a national heroine. Her influence is still felt in the principles of nursing education, in the organisation of the hospital, and in the practice of public health. The story of Nightingale is a central chapter in the history of Victorian Medicine and Public Health.