A daughter who refused the drawing room
Born in Florence in 1820 to a wealthy, reforming English family, she was taught Greek, Latin, philosophy and mathematics by her father William at a time when most young women of her class learned watercolours and marriage. She wanted to nurse. Her mother and sister treated the ambition as a scandal, since hospital nursing was then associated with drink and the lowest wages. She refused suitors, fell into long depressions, and waited more than a decade before her family relented enough to let her train.
In 1851 she spent several months at Kaiserswerth in Prussia, where Lutheran deaconesses ran a hospital and school. It was thin instruction, but it was instruction. By 1853 she was superintendent of a small institution for ailing gentlewomen in London, reorganising its plumbing and its accounts with equal appetite. When war broke out in the Crimea and British newspapers reported that wounded soldiers were dying untended, her friend Sidney Herbert, then Secretary at War, asked her to take a party of nurses east.
Scutari, where the hospital was the danger
She arrived at the Barrack Hospital at Scutari in November 1854 with thirty-eight nurses and almost no authority over the army doctors. The building sat above blocked sewers; wards were crowded, ventilation was poor, and the water supply was contaminated. Nightingale imposed order on supplies, laundry, food and record-keeping, and walked the wards at night, which gave the press its enduring image. What the image conceals is that mortality in her first winter rose rather than fell, reaching its worst in February 1855.
The turn came with a Sanitary Commission sent from London in March 1855, which flushed the sewers, removed carcasses from the water supply and improved ventilation. Deaths dropped sharply afterwards. Nightingale, to her credit, studied the figures and concluded that sanitation, not nursing devotion, had done it, and she spent the rest of her life arguing so. Another woman, the Jamaican-born Mary Seacole, funded her own passage and ran a provisioning house near the front after being turned away by the official nursing establishment.
Diagrams from a sickroom
Home from the war and revered, she used the reverence ruthlessly. Working with the statistician William Farr, she assembled mortality data for the Royal Commission of 1857 and presented it in polar-area diagrams, wedges of blue and red that made preventable deaths from disease impossible to misread beside deaths from wounds. Ministers who would not finish a report looked at the picture. In 1858 she became the first woman elected a fellow of the Royal Statistical Society, and she later advised on sanitary reform for the army in India.
From about 1857 she was largely bedridden, probably with a chronic infection contracted in the Crimea, and she governed by correspondence instead, writing thousands of letters, drafting regulations and interrogating officials from her room. Notes on Nursing appeared in 1859, and the Nightingale Training School opened at St Thomas' Hospital in 1860. She was not infallible: she resisted germ theory for years, preferring an explanation built on foul air. But she made hospital reform a matter of evidence rather than sentiment.
