If someone were to ask me my most respected profession, it would be nursing without a doubt. At the risk of offending physicians, I believe nursing to be the most underrated, dependable and valuable of all the health professions. Moreover, nurses are likely the most underpaid. This has become more evident during the pandemic crisis. Fortunately, several nurses in the past have been recognized for their bravery and service, but none more than Florence Nightingale. She was first known for her work in the Crimean War and subsequently wrote a book summarizing  the poor hygiene, sanitation, and patient care for the wounded. The book turned nursing into a valued profession and her suggestions for improvement reformed the practices of all army hospitals. It earned her devotion from those at home in England and made her famous throughout the world.

History

Florence was born to a wealthy English couple who could afford a honeymoon that took several years and spanned the European continent. The honeymoon of William Edward and Frances Nightingale went on for so long that their two daughters were both born before the couple returned to their home in England. Florence was named after the Italian city where she was born. In her youth, Florence kept detailed journals of what she was learning, and it is clear that she was not only interested in humanity’s great artistic achievements, she was also interested in humanity’s signal failures. She often took detours from the approved tourist path to visit hospitals, prisons, and charitable institutions. Everywhere she went, she was sensitive to the great beauty of European architecture, but she could not help also noticing the poor and sick.

Training

No one knows exactly when Florence became interested in the nursing profession. According to Catherine Reef in her book "Florence Nightingale," Florence frequently took an interest in the health of ailing relatives. Throughout her twenties, she sat at the bedsides of sick villagers and did what she could, with no training, to ease their suffering. She was also generous with money. However, she always felt stifled in her ambition to do more. She complained about the obvious differences between her status as a wealthy do-gooder and the status. That changed when she was 24, and became committed to nursing. Her parents, however, were strongly opposed. It needs to be noted that, in the 19th century, nurses were not highly regarded. At that time, nurses fell into two categories: there were nursing nuns, who achieved a modicum of the respect due to their hard work and lives of strict sacrifice. Lay nurses, however, were another story. They were widely assumed to be alcoholics and victims, if not willing participants, of sexual harassment from patients and other medical professionals. Outside the church, nursing was the last refuge of a woman who could find no other way to earn her living. It was not, in brief, the career path that a young lady brought up in a wealthy Victorian home would consider — unless that young lady were Florence Nightingale.  In 1845, an opportunity for medical training seemed to fall into her lap. Dr. Richard Fowler, a family friend, offered her the opportunity to train as a nurse at Salisbury Hospital for three months. At twenty-five, Florence was more than ready to enter the working world. Florence finally received the training in nursing and hospital management that she had longed for, albeit in a very roundabout way.  She received her formal training at the Lutheran hospital of Pastor Fliedner in Kaiserwerth, Germany.

Working Years

In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendent within just a year of being hired. The position proved challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process.

Statistical Input

Florence was not known just for nursing, with the support of Queen Victoria, Nightingale helped create a Royal Commission into the health of the army. It employed leading statisticians of the day, William Farr and John Sutherland, to analyze army mortality data, and what they found was horrifying: 16,000 of the 18,000 deaths were from preventable diseases — not battle. But it was Nightingale’s ability to translate this data into a new visual format that really caused a sensation. Her polar area diagram, now known as a “Nightingale Rose Diagram,” showed how the Sanitary Commission’s work decreased the death rate and made the complicated data accessible to all, inspiring new standards for sanitation in the army and beyond. She became the first female member of the Royal Statistical Society and was named an honorary member of the American Statistical Association.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected].