In 1854, a young woman entered the blood-soaked, disease-ridden chaos of a Crimean War field hospital. She didn’t wield a weapon, but a vision—to transform the way the world cared for its sick and wounded. Florence Nightingale’s journey would not only save countless lives during the war but also redefine an entire profession, establishing nursing as a respected field and revolutionizing medical sanitation practices.
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Imagine for a moment that you’re a soldier in the Crimean War. If you’re wondering where Crimea is, don’t worry – so were many of the real soldiers at the time. Like many of these men, you’re wounded at some point during the campaign. Fortunately, it isn’t that bad – just a quick in and out through the leg.
What IS bad is the field hospital you’re taking to for surgery.
Not only is virtually every bed filled with moaning, injured, and sick men, but the floors are literally covered in blood and waste. Flies buzz in swarms around the air, going from the pools of rancid blood to wounded patients and back again all day and night long.
You’re only there for stitches, but you soon fall deathly ill. Your fever rises to 103 degrees Fahrenheit or 39.4 Celsius, then higher. You become delirious, and eventually you die. Like most men fighting in this conflict, you weren’t taken out by Russian bullets, but from infections acquired in the very places designed to save you.
It was into this terrifying situation that a wealthy young lady named Florence Nightingale entered sometime in 1854. She didn’t know it at the time, but she was about to create – or at least legitimize – a whole new medical profession.
The Problem of Medical Sanitation in the 1850s
In the mid-19th century, you’d often hear a sick person say they would rather die than go to a hospital. This was not hyperbole, because going to the hospital dramatically increased the chances that you would contract a deadly infection. Sepsis, gangrene, and other infections were common following even minor surgeries, while mortality rates for surgeries like amputations could be as high as 80%.
The primary cause of all this misery was hygiene – or, more specifically, a lack thereof.
Medical professionals of the day operated with only the faintest understanding of how infections spread. Germ theory was still a distant revelation, and the dominant belief was that bad air was the culprit behind most post-surgery ailments. The good news? This meant you often got to die outside.
Inside hospital wards, the filth was overwhelming.
Physicians and attendants moved from patient to patient without wiping, let alone washing their hands. Surgical tools were merely given a cursory rinse before reuse, while linens and bandages were rarely changed and just as rarely fresh in the first place. Even in large city hospitals, the floors were often encrusted with dirt, bodily fluids, and waste. Looking back, it’s hardly surprising that such environments bred infections like typhoid, cholera, and sepsis.
And as bad as all this is, field hospitals used during armed conflict were worse. However, several enterprising and insightful individuals would change all of this, literally pushing the medical world into the future inch by inch. One such person was Florence Nightingale.
Early Life and Call to Service
Born in Florence, Italy in 1820, Florence Nightingale’s early life was almost entirely shaped by privilege. Her wealthy British parents, Frances and William Edward Nightingale, were forward-thinking for the day – at least in some respects. As a result of their progressivism, they decided to provide their young girl with an exceptional education, something altogether uncommon for women of her time. Tutored in mathematics, philosophy, science, and the classics by her father, Florence displayed a sharp intellect and an aptitude for data analysis, two skills that would come to define her later career.
Despite her intellectual pursuits, societal expectations remained an issue for both her and her parents. The Nightingales upheld rigid Victorian ideals, which dictated that wealthy women should marry well-do-do men and remain within the domestic sphere. This fact loomed particularly large over Florence, who, at age 16, experienced what she described as a divine calling to serve the sick and suffering.
She was determined to become a nurse. But when she told her parents, she was met with outrage. Though the profession existed, it was seen as something for the unfortunate classes. Nurses were thought to drink, flirt, and dabble in prostitution to make their wages. For someone of Florence’s status to say that she wanted to pursue such a calling was seen as akin to a Duchess wanting to slop the pigs.
Despite familial opposition, Florence remained resolute. She shunned both men and women, friendships and romance. Eventually, she met Mary Clark, an intellectual hostess and progressive who further encouraged Florence to follow her dreams.
Finally, her family relented. Her training began in Germany, where she studied hospital administration and patient care at a Lutheran facility. In 1853, with financial support from her father, she became the superintendent of the Institution for Sick Gentlewomen in London. Though she had several suitors, she repeatedly chose her vocation over societal expectations of marriage.
Though she is not alive to tell us in her own words, her correspondence indicates that her decisions affected her deeply. In fact, she often retreated into intense bouts of depression, which she would overcome by channeling her feelings into her work. And it clearly paid off. Florence’s early career was equally marked by a penchant for hands-on nursing and organizational innovation. By the time the Crimean War broke out in 1854, Florence was uniquely prepared to tackle one of history’s greatest public health crises.
The Crimean War
The war began as a power struggle between the Russian Empire and an alliance of Britain, France, and the Ottoman Empire, with battles raging on the Crimean Peninsula and surrounding territories. More than 615,000 lives would be lost during the two-year conflict, with more than 80% of those being non-combat-related fatalities. Indeed, the Crimean War saw men fighting in some of the most horrific conditions ever seen. Soldiers lived in overcrowded, filthy camps with little attention to personal cleanliness. Bathing and clean water were rare luxuries, leading to widespread lice infestations and poor overall hygiene. In almost all cases, camps and bases lacked any proper facilities for disposing of human waste, which contaminated the camps and spread disease.
Cholera, typhus, dysentery, and scurvy ran rampant through the ranks. And the centerpiece of all this human misery was the overcrowded, disease-ridden hospital wards at Scutari in modern-day Istanbul.
The war was nearly half over when The Times began reporting on the dismal camp and hospital conditions. Not only was support for the conflict at an all-time low, but now British citizens were learning that the majority of deaths stemmed from illness rather than battle. While she was still young, Nightingale’s reputation preceded her. English Secretary of War Sidney Herbert reached out to her for help, and she happily agreed. On October 21, 1854, she departed for the Ottoman Empire with a team of 38 volunteer nurses, including nuns and her head nurse, Eliza Roberts.
When Nightingale and her team arrived at the Selimiye Barracks in November of that year, they found themselves in the middle of an unrelenting crisis. Medicines were scarce, hygiene was neglected, and facilities lacked even basic provisions for preparing food. Nightingale’s journals described the entire camp as having a layer of filth on every service, noting that the smell of death permeated the air.
To make matters worse, Nightingale’s team soon learned that the reports were true. The mortality rate at the field hospital was 42%, with ten soldiers dying from disease for every one that succumbed to his battle wounds.
Nightingale wasted no time.
Drawing on her background in hospital administration, she implemented systematic changes. Cleanliness became her first priority. Under her direction, the nurses scrubbed the wards, washed linens, and helped introduce more sanitary food preparation practices. As a wise lady, she appealed to The Times back in England, the very same paper that had published the stories about the camp. This time, she requested the deployment of the Sanitary Commission, which flushed out the hospital’s defective sewers and established a more reliable water supply.
By the time the war was nearing its end, the mortality rate at her facility had dropped to just 2.2%.
The Lady with the Lamp
Nightingale’s reforms were vital to the survival of thousands of men, but that was not her only contribution. For many wounded and sick soldiers, her hands-on care became a beacon of hope. By night, she carried her lamp through the darkened corridors of the hospital, checking on patients and providing comfort. It was this image of Florence—gliding silently through the wards, her light casting shadows on the walls—that truly captivated the public imagination.
However, Nightingale’s efforts were not without challenges. She frequently clashed with male doctors and military officials who resisted her authority and questioned her methods. She also had issues with many of the Catholic nuns who came to help tend to the sick, but who refused to cede authority to a woman. Nevertheless, her results spoke for themselves. By the time the war ended in 1856, she had already changed the way hundreds of medical professionals thought about hygiene. More importantly, she helped legitimize nursing as a medical practice in which women were capable of doing virtually anything a doctor could – sometimes better.
Unfortunately, many historians agree that this marked a high point in her life.
A Woman Before Her Time
After arriving home, Nightingale, a voracious writer and note-taker, authored two publications: Notes on Nursing and Notes on Hospitals, both of which became foundational texts for the healthcare industry. Among other things, these works emphasized sanitation, patient-centered care, and efficient hospital management, things that are still vital to the modern medical industry.
Florence also used her statistical expertise to advocate for healthcare reform. For instance, she created the polar area diagram, a precursor to modern data visualization, to illustrate the preventable deaths caused by poor sanitation. Thanks to her data-driven arguments, she was able to successfully lobby governments to improve public health infrastructure, including rural sanitation projects in India.
However, it was at this time that she began to suffer from a number of chronic illnesses. From 1857 onwards, Nightingale was frequently bedridden due to these ongoing conditions. Beyond that, she suffered recurring bouts of severe depression. Though she remained hidden from the public for most of her later life, she continued her efforts in earnest, pouring her problems into her work just as she’d done earlier.
She established the Nightingale Training School for Nurses at St. Thomas’ Hospital in 1860 further helping to transform the field into a respected and structured profession. This initiative not only improved patient care but also provided women with an opportunity for meaningful work outside of traditional domestic roles. In fact, Graduates of the program became known as “Nightingale Nurses” and were sought after for their expertise.
Nightingale’s advocacy for social reform wasn’t limited to healthcare. She worked tirelessly to expand opportunities for women, particularly in education and employment. By proving that women could excel in roles traditionally dominated by men, she helped pave the way for future generations to enter fields like medicine, public health, and social work. We have articles on some of these pioneers coming up, so make sure to bookmark this page.
In many ways, Florence Nightingale was a woman ahead of her time—an innovator who refused to be constrained by the expectations of her era. Though she was bedridden much of her later life, she managed to live until the ripe old age of 90, allowing her to see many of the changes she helped implement come to fruition. Above all, she showed that one person, armed with conviction and compassion, could reshape entire systems and challenge the status quo.
All it takes is a little determination and a candle to light the way.
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