Florence Nightingale is perhaps best remembered as The Lady with the Lamp but is also regarded by the people of Hampshire as one of their heroines.
Although neither her death nor her birth occurred in the county, and her visits there became infrequent in the second half of her life, her time in Hampshire, and the links she formed there, proved influential throughout her life.
A home in Hampshire
Florence was born in Florence on 12th May 1820, the second daughter of William and Frances Nightingale. In 1825 William Nightingale purchased Embley Park at East Wellow near Romsey. The Nightingale family divided their time between their homes at Embley and Lea Hurst in Derbyshire.
Friendships developed between young cousins, the Nightingales and Bonham Carters. Henry (known as Harry) Bonham Carter and Florence were to remain close throughout their lives, and it is because of them that Hampshire Archives and Local Studies holds a small but important archive of Florence Nightingale material ‑ nearly 80 letters written by her, 50 letters to her, pencil sketches, watercolours and photographs, copies of several of her books and pamphlets, and printed material concerning her career, among the Bonham Carter family papers.
The young correspondent
Florence is thought to have written at least 14,000 letters during her lifetime. The earliest written by her held at Hampshire Record Office, written at the age of six, describes an eclipse.
Tenderness and skill
Embley was the setting for the story of one of Florence’s first acts of nursing, retold in a pamphlet of 1867, Constance and ‘Cap’ the Shepherd’s Dog by the Revd Jervis Trigge Giffard, Vicar of Wellow. For most of the pamphlet, she is referred to under the pseudonym ‘Constance’. The writer speaks of her ‘vivacity and cheerfulness natural to her age’, combined with ‘a certain thoughtfulness of character’, the help she gave to the poorer villagers, and her relations with animals.
On the day in question, she went for a ride with Mr Easy, who treated injuries and ailments among the local people. They met an old shepherd, Surly, who looked ‘more morose even than usual’ and announced that he was about to hang his dog Cap, because ‘Somebody… had broken his thigh with a stone.’ ‘Constance’ and Mr Easy went to the cottage, and the latter pronounced that the leg could be left to heal in time. She, however, was determined to ease the dog’s immediate pain. He said fomenting with hot water would relieve it, and she offered to try this. Two or three days later, Cap was back on duty with the sheep.
Reception rooms – or hospital wards?
When Florence and her sister reached an age to come out into society, it was decided that Embley must be enlarged, and at the same time it was transformed from a Georgian country house to a Gothic mansion during building work in 1837-9.
Florence once told the medical pioneer Elizabeth Blackwell that she used to imagine how she could use a suite of six reception rooms as hospital wards, and ‘just how I should place the beds’.
Thanks to the artistic skills of some of the family, notably Florence’s cousin Hilary Bonham Carter and her own sister Parthenope, we have some delightful glimpses of the life of the Nightingale family at Embley, although Florence found the ‘drawing-room life’ more stifling as she sensed an increasingly clear vocation to nursing.
A general chorus of coughing
In February 1837 Florence for the first time heard a call to action. She recorded it in these words: ‘God spoke to me and called me to His service.’ It was the first of four occasions on which she heard such a call, although at this stage she may not specifically have linked it to a nursing vocation. She had gained experience of nursing that January when there was an outbreak of influenza at Embley leading to a ‘general chorus of coughing resounding from garrets to cellars’ and she found herself acting as ‘nurse, governess, assistant curate and doctor.’
In the summer of 1843, at Lea Hurst, she spent much time in the cottages of the poor and unwell, and in the following spring concluded that her work in life was to be nursing, but she was aware of the family opposition she would face. The following year she cared for one of her favourite cousins, Shore Smith, as he convalesced at Embley after measles, and also nursed her grandmother Mrs Shore, and her old nurse Mrs Gale. Towards the end of the year she asked to spend three months at Salisbury Infirmary to learn nursing, but was defeated by the strength of opposition she faced – an opposition which was perhaps unsurprising in view of the prevalent view of nurses as drunken and immoral, and the description she was later to give, in Notes on Hospitals, of the insanitary nature of hospitals, where workmen brought in to clean the walls of ‘minute vegetation’ often became ill.
In 1848-9 Florence had the chance to travel with family friends Selina and Charles Bracebridge of Warwickshire, to Rome, where she first became acquainted with Sidney Herbert, who had served as Secretary at War under Peel, and his wife Elizabeth (Liz).
In 1849-50 Florence accompanied the Bracebridges on a tour of Egypt and Greece. On the return journey, she was able to spend a fortnight in the Institution of Deaconesses at Kaiserswerth, near Frankfurt, which provided practical training for deaconesses who were to serve in hospitals and schools.
Finally, the family agreed in 1853 to her going to Paris for training at the Maison de la Providence, the hospital of the Sisters of Charity. Yet again her plans were thwarted, as she was summoned home to nurse her grandmother in her final illness; eventually in the summer she entered the Maison de la Providence, only to develop measles after a fortnight. By this time she had already agreed to take the unpaid post of Superintendent of the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London.
No mops, no plates, no towelling
In March 1854, England and France declared war on Russia, beginning the process which was to lead Florence to the best-known part of her life, during the Crimean War.
While the troops were in camp on the Bulgarian coast, they were attacked by diseases including cholera and dysentery. After the Battle of Alma in September, the lack of adequate medical care was clear. Newspaper reports described the medical provision in uncompromising detail.
Florence formed a plan to go out with a very few nurses, and wrote about it to Liz Herbert; her letter crossed with one from Sidney Herbert asking her to take a group of Government-sponsored nurses to Scutari. On 20th October she became the ‘Superintendent of the female nursing establishment in the English General Military Hospitals in Turkey’. On 4 November, just as 400 wounded men from the Battle of Balaclava were expected, Florence and her party, including the Bracebridges, reached Scutari, where she found the Barracks Hospital, housed in a hastily-converted barracks.
Florence worked unsparingly; she also had to deal with problems ranging from the opposition of some of the doctors to the indiscipline and inexperience of some of the nurses. Even worse was the incompetence of the Purveying department: she wrote to Herbert, ‘This morning I foraged in the Purveyor’s Store… the only way of getting things. No mops, – no plates, no wooden trays, no slippers, no shoe-brushes, no knives & forks… no scissors… no basins, no towelling, no Chloride of Lime.’
She was immediately aware of the problems caused by insanitary conditions.
Despite her efforts, the mortality rate grew from 10% of admissions in September to December 1854, to 33% in the first three months of 1855, much owing to dysentery, diarrhoea and indefinite fevers. The Government sent a Sanitary Commission to investigate, and it was found that blocked pipes meant that the Barrack Hospital was located above what had become a large cesspool, while a water supply pipe was blocked by the carcass of a horse. At last, improvements were ordered, and mortality fell, although this was also probably partly the result of an easing in the overcrowding.
In May 1855 Florence arrived in the Crimea itself, to begin work in the hospitals at Balaclava. Although she was cheered by the troops, she found here even more resistance from medical officials. Little more than a week later, she was herself a patient in the Castle Hospital, suffering from what was generally described as Crimean Fever. After returning to Scutari the next month, she appeared to be improving, but in the autumn, back in the Crimea, she began to suffer with a range of ailments from sciatica to laryngitis. The exact nature of ‘Crimean Fever’ has been much debated, but it has been suggested that Florence suffered from brucellosis, and that the depression and nervous irritability that can be seen in her life in the following decades would be consistent with this.
Words and statistics
On her return to England in 1856, Florence felt driven to work for improvements in the health of the army. She met Queen Victoria, the Prince Consort, and Lord Panmure, the Secretary of State for War, who agreed in principle to the appointment of a Royal Commission on the health of the army, to which Florence would contribute a formal report.
In the summer of 1857 her health broke down again, but her bedroom in London now became the setting for a new phase in her work, collating statistics and reports and doing her utmost, by indefatigable correspondence and in a succession of about 200 books, pamphlets and articles, to promote reforms in nursing, hospitals, welfare provision and other areas.
Perhaps her largest book, was Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army, founded chiefly on the Experience of the Late War (1858). Far from trying to conceal the dreadful mortality at ‘her’ hospital in Scutari, she revealed it in all its awful detail. Many examples are given of the lack of supplies, and the insanitary conditions: ‘not a morsel’ of fresh bread was issued to the sick ‘till April 9, 1855, nor to the Troops till later’; camp kettles were not issued until January 1855; in the same month, what the Director-General of the Army Medical Department described as a ‘very large’, albeit insufficient, number of articles was washed in the hospital at Scutari, but she showed that it worked out at little more than one shirt for every two men treated in that month.
She included statistical tables about mortality rates in hospitals and in ships used to transport the wounded, and monthly returns of provisions from arrowroot to vinegar. Most dramatic of all was a graphical representation of the monthly numbers of deaths at Scutari, compared to the average numbers in military hospitals near London.
My dear Harry
Early in 1856, while she was still in the Crimea, the Nightingale Fund was established, using the proceeds of money subscribed by a public eager to express its gratitude to her. When she returned to England, it was decided to devote the fund to the training of nurses and midwives, and a scheme was launched at St Thomas’s Hospital in London in 1860, known as the Nightingale School of Nursing. The emphasis was on practical instruction: Florence had little regard for written examinations, and therefore was later to oppose schemes for the registration of nurses.
In 1861, her cousin Harry Bonham Carter was appointed Secretary to the fund, a voluntary post he was to hold until 1914. He was an invaluable and hard working assistant to Florence.
The letters which survive in Hampshire Record Office give us a glimpse of Florence Nightingale at work over the years: her views and her ways of working and of keeping in touch with the Nightingale Fund Committee from her bedroom.
In her letters Florence expresses herself openly and frankly to Harry, pulling no punches, as in a letter of September 1877 which is full of scathing criticism of the administration at St Thomas’s Hospital. Harry had written to her for advice on the drawing up of a constitution for the hospital. Her response painted a grim picture. She criticised the smells, the lack of discipline among the male staff, and the inadequate sanitation. The Hospital Sanitary Commission, she said, did nothing; its members were ‘old and idle’. ‘The sisters are still the only sanitary officers.’ By July 1878, things had not noticeably improved.
Her letters were filled with vigorous under-linings, as she strove to improve sanitation in hospitals, conditions in workhouse infirmaries, and the health and landholding arrangements of people in India, her work being rooted in the statistics and reports which she studied.
A perfect rabble of wards
One of Florence’s key contributions was to hospital design. With the knowledge of the deaths that had resulted from the insanitary conditions at Scutari, she was determined to put an end to hospital designs in which proper sanitation and ventilation were ignored. She did not as yet understand the scientific background for this: like most of her contemporaries she still attributed the spread of disease to miasma, the ‘bad air’ that emanated from rotting organic matter, rather than to germs. Fortunately her insistence on the eradication of poor sanitation also eradicated the germs whose existence she initially denied.
The foundation stone of a new military hospital at Netley, named Royal Victoria Hospital, had been laid in May 1856 by Queen Victoria. As a result of their meeting at Balmoral, Lord Panmure sent Florence the plans. She could find almost nothing to approve of, the main objection being that the wards opened directly off a corridor, with ventilation only on one side, instead of being arranged in a number of pavilions, allowing through ventilation across the wards. She wrote letters to newspapers attacking the plans, and used her mathematical skills to show it would be cheaper to start again with better-ventilated but larger wards, requiring fewer staff.
Although Florence was essentially defeated here, the principle of pavilion-style layouts had been accepted in the Royal Commission’s report and was put into practice when construction began in 1859 at Woolwich of what became the Herbert Military Hospital.
So distinguished an ornament
The construction of the new Hampshire County Hospital in Winchester provided Florence with the chance to be involved at an early stage. The hospital had been founded in Colebrook Street in 1736, and since 1759 had been housed in Parchment Street. In September 1861 the hospital’s Committee of Management appointed a sub-committee to consider modernising the existing hospital or replacing it with a new building on another site. Florence had already been working behind the scenes.
Various sites were rejected, and the committee decided on the Romsey Road site in September 1862; Florence wrote to Sir William Heathcote, Building Committee chairman: ‘It is a great victory to have persuaded Winchester to remove her Hospital’, adding disingenuously, ‘& mainly if not entirely due to you.’
A report of the Building Committee was presented to the Governors in October 1863, describing the plans drawn up by William Butterfield, and the comments received from Florence among others. She was vigorous in her rejection of balconies which might obstruct ventilation, and of day-rooms for convalescent patients, comparing those at the Fever Hospital in London to ‘the parlour of a discreditable Public House’. The committee’s report concluded with extracts from Florence’s letters: ‘I am quite delighted with the Winchester Infirmary plans. They show that they have been very carefully considered, and, if I criticise, I do so as I would to my own… I think you may justly congratulate yourselves on having planned a Model Hospital’, and with the comment: ‘Miss Nightingale’s opinion on these subjects, sought and prized in all places, must have more than ordinary value among us, of whose county she is so distinguished an ornament…’
The new hospital was opened in 1868, and with the Queen’s permission was renamed the Royal Hampshire County Hospital in the same year. Butterfield’s buildings are still in use, and Florence’s role has been commemorated by the name Nightingale Wing for part of the complex.
No death-rate at all
In 1871 Florence published Introductory Notes on Lying-In Institutions, her interest in maternity care being increased by the discovery of a high level of puerperal fever in a midwifery ward in King’s College Hospital supported by the Nightingale Fund. She analysed the subject with meticulous care, including hospital statistics from Moscow to Marseilles. She considered numerous factors, from the size and layout of hospitals to the practice of admitting medical students to the wards. She also warned against the assumption that any deaths in childbirth were to be expected: ‘lying-in is not a fatal disease, nor a disease at all… there ought, in a lying-in institution, to be no death-rate at all.’
A military hospital at Aldershot, consisting of ‘a number of huts joined together … with accommodation for all kinds of cases, including lying-in cases’, was criticised as a ‘very undesirable’ arrangement. She showed that good hospitals did not need to be grand: at Colchester and Shorncliffe there were camp hospitals in old wooden huts which were never known to have had any fatal puerperal disease; both hospitals were well-ventilated, had no connection with a general hospital, and had very few patients at any one time.
She included a reproduction of the floor plan of a proposed female hospital for the Portsmouth garrison, in which lying-in, general and infectious cases were to be treated in three separate pavilions, 60 feet apart. With her usual attention to practicality over theory, however, she pointed out that in a lying-in hospital in Paris, newly-built on a pavilion plan, puerperal fever had soon broken out, and it was found that nurses and doctors had passed almost directly between the isolated and healthy patients.
All this work was carried on, especially in the decades immediately after the Crimean War, in spite of debilitating illness. Florence seldom visited Hampshire during these years.
A reminder of Embley
From 1866 Florence began to visit both Embley and Lea Hurst again, as her mother’s health deteriorated and she felt the need to ensure she was given proper care. In the early 1880s Florence’s own health at last improved.
She last visited Embley in 1893, and it was sold in 1896; she commented that it was sad to have been ‘turned out of Hampshire’. Despite the difficulties she had faced during her time at Embley, she seems to have retained pleasant memories of the estate: in February 1891 she had written to Miss Louisa Petty of Wellow Mill thanking her for: ‘the lovely snowdrops & the beautiful moss, smelling so sweet & fresh out of the country’.
Ever your old Flo
After 1895 she ceased to travel, staying in her home at South Street, off Park Lane, but she was still visited by, and corresponded with, her younger relations.
In one of the last letters written by her held at Hampshire Record Office, dated 18th February 1901, she writes that she is unwell and ‘my chief sorrow is that I am not able to see you’, signing off: ‘Ever your old Flo.’
Florence’s final connection with Hampshire came after her death. She died at South Street on 13th August 1910. On Saturday 20th August her coffin was taken by train to Romsey, and then by funeral carriage to St Margaret’s, East Wellow, for burial in the family plot.
On the Sunday there was a large congregation at Matins, and the Vicar, the Revd S M Watson, preached on the parable of the Good Samaritan, which happened to be included in the reading set for the day, commenting that: ‘The first thing that would probably strike people when they came to read the life of the late Miss Florence Nightingale would be the number of opportunities which that good woman found for doing good… Let them ask themselves, had these opportunities come before them, would they have done as she did, or would they have let the opportunities slip by? She did not wait for opportunities – she made them and used them.’