Biography

Florence Nightingale, OM, RRC (pronounced /ˈflɒrəns ˈnaɪtɪŋɡeɪl/, historically [ˈflɒɾəns]; 12 May 1820 – 13 August 1910) was an English nurse, writer and statistician. She came to prominence during the Crimean War for her pioneering work in nursing, and was dubbed "The Lady with the Lamp" after her habit of making rounds at night to tend injured soldiers.
Nightingale laid the foundation of professional nursing with the establishment, in 1860, of her nursing school at St Thomas' Hospital in London, the first secular nursing school in the world. The Nightingale Pledge taken by new nurses was named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday.

Early life
Florence Nightingale was born into a rich, upper-class, well-connected British family at the Villa Colombaia, near the Porta Romana at Bellosguardo in Florence, Italy, and was named after the city of her birth. Florence's older sister Parthenope (pronounced /pɑrˈθiːnəpɪ/) had similarly been named after her place of birth, a Greek settlement now part of the city of Naples.
Her parents were William Edward Nightingale (1794–1874) and Frances ("Fanny") Nightingale née Smith (1789–1880). William Nightingale was born William Edward Shore. His mother Mary née Evans was the niece of one Peter Nightingale, under the terms of whose will William Shore not only inherited his estate Lea Hurst in Derbyshire, but also assumed the name and arms of Nightingale. Fanny's father (Florence's maternal grandfather) was the abolitionist William Smith.
Inspired by what she took as a call from God in February 1837 while at Embley Park, Florence announced her decision to enter nursing in 1844, despite the intense anger and distress of her mother and sister. In this, she rebelled against the expected role for a woman of her status, which was to become a wife and mother. Nightingale worked hard to educate herself in the art and science of nursing, in spite of opposition from her family and the restrictive societal code for affluent young English women.

Florence Nightingale, circa 1858
Nightingale was courted by politician and poet Richard Monckton Milnes, 1st Baron Houghton, but she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing. When in Rome in 1847, she met Sidney Herbert, a brilliant politician who had been Secretary at War (1845–1846), a position he would hold again during the Crimean War. Herbert was already married, but he and Nightingale became lifelong close friends. Herbert was instrumental in facilitating her pioneering work in the Crimea and in the field of army health especially, and she became a key adviser to him in his political career, though she was accused by some of having hastened Herbert's death from Brights' Disease in 1861 because of the pressure her programme of reform placed on him.
Nightingale also much later had strong relations with Benjamin Jowett, who may have wanted to marry her.
Nightingale continued her travels with Charles and Selina Bracebridge as far as Greece and Egypt. Her writings on Egypt in particular are testimony to her learning, literary skill and philosophy of life. Sailing up the Nile as far as Abu Simbel in January 1850, she wrote
"I don't think I ever saw anything which affected me much more than this." And, considering the temple: "Sublime in the highest style of intellectual beauty, intellect without effort, without suffering... not a feature is correct – but the whole effect is more expressive of spiritual grandeur than anything I could have imagined. It makes the impression upon one that thousands of voices do, uniting in one unanimous simultaneous feeling of enthusiasm or emotion, which is said to overcome the strongest man."
At Thebes she wrote of being "called to God" while a week later near Cairo she wrote in her diary (as distinct from her far longer letters that her elder sister Parthenope was to print after her return): "God called me in the morning and asked me would I do good for him alone without reputation." Later in 1850, she visited the Lutheran religious community at Kaiserswerth-am-Rhein where she observed Pastor Theodor Fliedner and the deaconesses working for the sick and the deprived. She regarded the experience as a turning point in her life, and issued her findings anonymously in 1851; The Institution of Kaiserswerth on the Rhine, for the Practical Training of Deaconesses, etc. was her first published work.
On 22 August 1853, Nightingale took the post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London, a position she held until October 1854.Her father had given her an annual income of £500 (roughly £25,000/US$50,000 in present terms), which allowed her to live comfortably and to pursue her career.

Crimean War
Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. On 21 October 1854, she and a staff of 38 women volunteer nurses, trained by Nightingale and including her aunt Mai Smith, were sent (under the authorization of Sidney Herbert) to Turkey, about 545 km across the Black Sea from Balaklava in the Crimea, where the main British camp was based.
Nightingale arrived early in November 1854 at Selimiye Barracks in Scutari (modern-day Üsküdar in Istanbul). She and her nurses found wounded soldiers being badly cared for by overworked medical staff in the face of official indifference. Medicines were in short supply, hygiene was being neglected, and mass infections were common, many of them fatal. There was no equipment to process food for the patients.
Death rates did not drop; on the contrary, they began to rise. The death count was the highest of all hospitals in the region. During her first winter at Scutari, 4,077 soldiers died there. Ten times more soldiers died from illnesses such as typhus, typhoid, cholera and dysentery than from battle wounds. Conditions at the temporary barracks hospital were so fatal to the patients because of overcrowding and the hospital's defective sewers and lack of ventilation. A Sanitary Commission had to be sent out by the British government to Scutari in March 1855, almost six months after Florence Nightingale had arrived, and effected flushing out the sewers and improvements to ventilation. Death rates were sharply reduced. Until recently it was commonly asserted that Nightingale reduced the death rate from 42% to 2% either by making improvements in hygiene herself or by calling for the Sanitary Commission. For example the 1911 first edition of the Dictionary of National Biography made this claim, but the second edition in 2001 did not. During the war she did not recognize hygiene as the predominant cause of death, and she never claimed credit for helping to reduce the death rate.
Nightingale continued believing the death rates were due to poor nutrition and supplies and overworking of the soldiers. It was not until after she returned to Britain and began collecting evidence before the Royal Commission on the Health of the Army that she came to believe that most of the soldiers at the hospital were killed by poor living conditions. This experience influenced her later career, when she advocated sanitary living conditions as of great importance. Consequently, she reduced deaths in the army during peacetime and turned attention to the sanitary design of hospitals.

The Lady with the Lamp
During the Crimean campaign, Florence Nightingale gained the nickname "The Lady with the Lamp", deriving from a phrase in a report in The Times:
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.

The phrase was further popularised by Henry Wadsworth Longfellow's 1857 poem "Santa Filomena":

"Lo! in that house of misery

A lady with a lamp I see

Pass through the glimmering gloom,

And flit from room to room."

Later career
While she was in the Crimea, on 29 November 1855, a public meeting to give recognition to Florence Nightingale for her work in the war led to the establishment of the Nightingale Fund for the training of nurses. There was an outpouring of generous donations. Sidney Herbert served as honorary secretary of the fund, and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, on the basis of her letters from 1856 in which she wrote of spas in Turkey, detailing the health conditions, physical descriptions, dietary information, and other vitally important details of patients whom she directed there (where treatment was significantly less expensive than in Switzerland). It may be assumed she was directing patients of meagre means to affordable treatment.
By 1859 Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860. (It is now called the Florence Nightingale School of Nursing and Midwifery and is part of King's College London.) The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury, near her family home.
Nightingale wrote Notes on Nursing, which was published in 1859, a slim 136-page book that served as the cornerstone of the curriculum at the Nightingale School and other nursing schools established, though it was written specifically for the education of those nursing at home. Nightingale wrote "Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have-distinct from medical knowledge, which only a profession can have".
Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting the establishment and development of the nursing profession and organizing it into its modern form. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".
Nightingale was an advocate for the improvement of care and conditions in the military and civilian hospitals in Britain. Among her popular books are Notes on Hospitals, which deals with the correlation of sanitary techniques to medical facilities; Notes on Nursing, which was the most valued nursing textbook of the day; Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army.
As Mark Bostridge has recently demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in England and Ireland from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. This innovation may be said to herald the establishment of the National Health Service in Britain, forty years after Nightingale's death.
It is commonly stated that Nightingale "went to her grave denying the germ theory of infection". Mark Bostridge in his recent biography disagrees with this, saying that she was opposed to a precursor of germ theory known as "contagionism" which held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously and even afterwards many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission.
In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the USA with adequate training and knowledge to establish high-quality nursing schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.
By 1882, Nightingale nurses had a growing and influential presence in the embryonic nursing profession. Some had become matrons at several leading hospitals, including, in London, St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney; and throughout Britain, e.g., Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary, as well as at Sydney Hospital in New South Wales, Australia.
In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1907, she became the first woman to be awarded the Order of Merit. In 1908, she was given the Honorary Freedom of the City of London. Her birthday is now celebrated as International CFS Awareness Day.
From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause. An alternative explanation for her depression is based on her discovery after the war that she had been mistaken about the reasons for the high death rate. There is, however, no documentary evidence to support this theory which remains, therefore, largely supposition. Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis. the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world.

Death
On 13 August 1910, at the age of 90, she died peacefully in her sleep in her room at 10 South Street, Park Lane.The offer of burial in Westminster Abbey was declined by her relatives, and she is buried in the graveyard at St. Margaret Church in East Wellow, Hampshire.

Legacy and memory

A young Florence Nightingale

Nursing
The first official nurses’ training program, the Nightingale School for Nurses, opened in 1860. The mission of the school was to train nurses to work in hospitals, work with the poor, and to teach. This intended that students cared for people in their homes, an appreciation that is still advancing in reputation and professional opportunity for nurses today. Florence Nightingale's lasting contribution has been her role in founding the modern nursing profession. She set an example of compassion, commitment to patient care, and diligent and thoughtful hospital administration.
The work of her School of Nursing continues today as the Florence Nightingale School of Nursing and Midwifery at King's College London. The Nightingale Building in the School of Nursing and Midwifery at the University of Southampton is also named after her. International Nurses Day is celebrated on her birthday each year.
The Florence Nightingale Declaration Campaign established by nursing leaders throughout the world through the Nightingale Initiative for Global Health (NIGH), aims to build a global grassroots movement to achieve two United Nations Resolutions for adoption by the UN General Assembly of 2008 which will declare: The International Year of the Nurse–2010 (the centennial of Nightingale's death); The UN Decade for a Healthy World–2011 to 2020 (the bicentennial of Nightingale's birth). NIGH also works to rekindle awareness about the important issues highlighted by Florence Nightingale, such as preventive medicine and holistic health. So far, the Florence Nightingale Declaration has been signed by over 18,500 signatories from 86 countries.
During the Vietnam War, Nightingale inspired many U.S. Army nurses, sparking a renewal of interest in her life and work. Her admirers include Country Joe of Country Joe and the Fish, who has assembled an extensive website in her honour.
Four hospitals in Istanbul are named after Nightingale: F. N. Hastanesi in Şişli (the biggest private hospital in Turkey), Metropolitan F.N. Hastanesi in Gayrettepe, Avrupa F.N. Hastanesi in Mecidiyeköy, and Kızıltoprak F.N. Hastanesi in Kadiköy, all belonging to the Turkish Cardiology Foundation.
The Agostino Gemelli Medical School in Rome, the first university-based hospital in Italy and one of its most respected medical centres, honoured Nightingale's contribution to the nursing profession by giving the name "Bedside Florence" to a wireless computer system it developed to assist nursing.
There are many foundations named after Florence Nightingale. Most are nursing foundations, but there is also Nightingale Research Foundation in Canada, dedicated to the study and treatment of chronic fatigue syndrome, which Nightingale is believed to have had.
The "Florence Nightingale effect" is a popular cultural trope whereby patients are said to fall in love with their caregivers, or vice versa; it may be based on misinterpreting bedside manner as romantic affection, or a psychological effect.

Museums and monuments
A statue of Florence Nightingale stands in Waterloo Place, Westminster, London, just off The Mall.
There are three statues of Florence Nightingale in Derby — one outside the Derby Royal Infirmary, one in St. Peter's Street, and one above the Nightingale-Macmillan Continuing Care Unit opposite the Derby Royal Infirmary. A public house named after her stands close to the Derby Royal Infirmary.
There is a Florence Nightingale Museum in London, due to reopen in May 2010 in time for the centenary of Nightingale's death, and another museum devoted to her at her sister's family home, Claydon House, now a property of the National Trust.

Theatre
The first theatrical representations of Nightingale was Reginald Berkeley in his "The Lady with the Lamp", premiering in London in 1929 with Edith Evans in the title role. This does not portray her as an entirely sympathetic character and draws much characterisation from Lytton Strachey's biography of her in Eminent Victorians. It was adapted as a film of the same name in 1951. Nightingale also appears in Edward Bond's surrealist play Early Morning, in which she is depicted having a lesbian affair with Queen Victoria.

Television
Portrayals of Nightingale on television, in documentary as in fiction, vary - the BBC's 2008 Florence Nightingale emphasised her independence and feeling of religious calling, but in Channel 4's 2006 Mary Seacole: The Real Angel of the Crimea she was portrayed as narrow-minded and opposed to Seacole's efforts. In 1985 a TV biopic "Florence Nightingale", starring Jaclyn Smith as Florence, was produced.

Film
In 1912 a biographical silent film titled The Victoria Cross starring Julia Swayne Gordon as Nightingale was produced. In 1915 another biographical silent film titled Florence Nightingale was produced starring Elisabeth Risdon. In 1936 a biographical film titled White Angel was produced, starring Kay Francis as Nightingale. A 1951 a second "talkie" biographical film titled The Lady With The Lamp was produced starring Anna Neagle.

Banknotes
Florence Nightingale's image appeared on the reverse of Series D £10 banknotes issued by the Bank of England from 1975 until 1994. As well as a standing portrait, she was depicted on the notes in a field hospital in the Crimea, holding her lamp.

Photography
Nightingale had a principled objection to having photograph taken or her portrait painted. An extremely rare photograph of Florence Nightingale, taken at Embley on a visit to her family home in May 1858, was discovered in 2006 and is now at the Florence Nightingale Museum in London. A black and white photograph of Florence Nightingale taken in about 1907 by Lizzie Caswall Smith at Nightingale's London home in South Street, Park Lane, was auctioned on 19 November 2008 by Dreweatts auction house in Newbury, Berkshire, England, for £5,500.

Biographies
The first biography of Nightingale was published in England in 1855. In 1911 Edward Cook was authorised by Nightingale's executors to write the official life, published in two volumes in 1913. Lytton Strachey based much of his chapter on Nightingale in Eminent Victorians on Cook, and Cecil Woodham-Smith relied heavily on Cook's Life in her 1950 biography, though she did have access to new family material preserved at Claydon. In 2008 Mark Bostridge published a major new life of Nightingale, almost exclusively based on unpublished material from the Verney Collections at Claydon,and from archival documents from about 200 archives around the world, some of which had been published by Lynn McDonald in her projected sixteen-volume edition of the Collected Works of Florence Nightingale (2001 to date).

Florence Nightingale syndrome
Florence Nightingale syndrome is a term used to describe a situation where a caregiver typically a doctor or nurse develops an emotional attachment to a vulnerable patient in their care. This attachment may progress into a sexual attraction.