History of Medicine and Pharmacy

Florence Nightingale bicentennial: 1820-2020.

Her contributions to health care improvement

Dinu I. Dumitrascu1, Liliana David2, Dan L. Dumitrascu3,

Liliana Rogozea4

1) Department of Anatomy, Iuliu Abstract

Hatieganu University of Medicine In 2020 we celebrate the bicentennial of the birth of Florence Nightingale and 110
and Pharmacy, Cluj-Napoca,
Romania
years from her death (1820-1910). This gives us the opportunity to remember her life
and her achievements. She is mainly known for her contribution to the foundation
2) Department of Nursing, Iuliu of modern nursing in the British Empire and subsequently to the world. Besides her
Hatieganu University of Medicine personal engagement in the Crimean War, she organized a professional training for
and Pharmacy, Cluj-Napoca,
Romania
nurses, wrote the first textbook on nursing (“Notes on Nursing”) and took public
positions in favor of health care and philanthropic funding. She was a militant
3) 2nd Department of Internal for the rights of the women and for social justice. She was a pioneer of medical
medicine, Iuliu Hatieganu University statistics and hospital management. Her activity is acknowledged worldwide.
of Medicine and Pharmacy, Cluj-
Napoca, Romania Keywords: Florence Nightingale, history of medicine, nursing, women in medicine

4) Department of the History of

Medicine and Department of Nursing,
Transilvania University, Brasov,
Romania
This year we celebrate one of engaged in the study of nursery against
the most famous health care providers the wish of her family [2,3]. Despite the
of the world: Florence Nightingale. wish of her parents she insisted and started
Beside representing the “mother” of nursing studies at the level of that time,
modern nursing, she was very much in Germany. She chose Kaiserwerth, now
engaged in improving the life of war part of Dusseldorf, where a well-known
victims, of women and of deprived deaconry run by protestant nuns existed
persons. Considering the importance since 1836 thanks to the couple Theodor
of this bicentennial, we review here her and Friederike Fliedner [4]. At that time,
biography and her work and contributions she could care for patients only in women
to medical progress. rooms, while male patients were allocated
to male care givers. At night female nurses
Biography were not allowed in rooms for male patients.
Florence Nightingale was born She continued her training in nursing
on May 12, 1820, in Florence, Italy. In also in France [1,2]. Later she returned to
her honor, this day will become, starting England and since 1853 she worked in a
with 1965, the International Nurses Day. home called the Institute for the Care of
Her name was given by her parents in Sick Gentlewomen [5]. These early years
recognition of the city where they lived of activity were in fact the prologue of her
at that moment. Florence Nightingale left lifelong work, which started with the onset
this world in London on August 13, 1910, of the Crimean War.
DOI: 10.15386/mpr-1799
after a very intense life filled with many
Manuscript received: 29.06.2020 accomplishments [1]. Her youth portrait Participation to the Crimean
Accepted: 26.08.2020 is presented in figure 1. War and care of wounded and ill
From the youngest age she soldiers
Address for correspondence:
developed a strong feeling of philanthropy The so-called Crimean War was in
lilidavid2007@yahoo.com
and expressed the wish to help others. fact a pan-European war in which Russia
Therefore, she refused the common was confronted with most major European
This work is licensed under a Creative
Commons Attribution-NonCommercial- life path of ladies of that time, rejected powers contesting tsarist empire spread
NoDerivatives 4.0 International License advantageous marriage proposals and over Europe to the detriment of Ottoman

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 History of Medicine and Pharmacy

Empire. The conflict started in 1853 with the occupation Contributions to surgery
of Moldavia and Walachia by Russian troops and spread in Florence Nightingale did not have a direct surgical
Crimea, where the main and bloodiest battles were engaged activity, but dealing with war injuries involves a lot of surgery.
until the end of 1856. The fights were intense and massive Her activity must have included hemostasis, wound cleaning
casualties were produced. The British Empire participated and dressing, prevention of infection. As many health care
to the Crimean War and needed medical service for its providers of that time, she was long time not convinced by
army. Florence Nightingale travelled there together with the existence of pathogenic germs; nevertheless, after the
her dedicated staff to care for the wounded on the battlefield work of Pasteur and others became known, she was cautious
and on field hospitals. She became famous for the lamp she in preventing the transmission of infections. She was decisive
always had with her to see the wounded during night, hence in the creation of the British Army Medical Service and thus
her nickname “the lady with the lamp”. her achievements are a corner stone for military surgery
She was an example of enthusiasm and abnegation [8]. Therefore she is even now veneered for her personal
and motivated her staff (many of them nuns) to take care of commitment in war medical health care [9].
those in need in the improvised hospital in Scutari, Turkey,
where she worked. There she was able to reduce mortality to Other contributions
10%. Beside the possibility to actively offer care and support Beside nursing and military and civil healthcare
to the victims of war, she drew a few conclusions: the need she had important contributions to the healthcare system
to organize a nursing system able to provide assistance management, to medical statistics, to emancipation of
during war but also during peace; the need to care and women, for social equality [1]. She emphasized the
protect casualties of the war and prisoners of war. Indeed, importance of numbers, i.e. of statistics in healthcare
everything was missing: hygiene regulations, medicines, providing: number of beds, number of patients, number of
skilled assistance, food [6]. cases etc. [10-12]. These data served her to take decisions in
In this respect her conception converged very much regard to hospital administration and public health measures
to that of Henri Dunant, the founder of the Red Cross in [13,14]. Her public interventions were always disseminated
1863, inspired by the terrible impressions of the Solferino by journals and were influential for the public health
battlefield that he visited just after the battle, in 1859. policies of that time.
It is well known that every prominent person has
detractors, and the same happened to Florence Nightingale.
A Jamaican nurse Mary Seacole claimed over Florence
Nightingale the overhand of infirmary care and disputed her
merits from the point of view of the negritude movement
[1,7].

Founding of modern nursing

Her activity during the Crimean War was well
reflected in the contemporary journals and increased the
awareness of the need to launch an efficient nursing training
and system. Florence Nightingale again was ahead of her
time and created in London a nursing school in St Thomas
Hospital. She also wrote the “Notes on Nursing”, probably
the first textbook on nursing. For her activity she needed and
received philanthropic funding.
Soon the Civil War started in the United Stated of
America and Florence Nightingale served as an adviser for
American nurses. She also trained the first American nurse
Linda Richards (1841-1930).
In the following decades, her disciples became
important disseminators of the training of Nightingale and
contributed to the establishment of a quality nursing in the
United Kingdom, which served as an example for other Figure 1. Florence Nightingale, lithographic reproduction of 1857
countries as well. (private collection).
Despite a mysterious disease that disabled her now
and again during the second half of the 19th Century (maybe
brucellosis?), she remained very much engaged in the care of Cultural echoes
ill people and in the education of nurses. Not only in the United Kingdom, but throughout
the world there are hospitals, streets, nursing schools

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History of Medicine and Pharmacy

who bear her name. The impact of the life and work of Some papers about her are in the press, but for
Florence Nightingale is largely reflected on different general information, not for those with advanced interest
memorabilia: lithographs (Figure 1), postcards, stamps in her. Most of them were published in the observation of
(Figure 2), coins, etc. her bicentennial. One single medical paper indexed in the
EBSCO database can be retrieved [1]. Her spirit is however
reflected in some papers on nosocomial infections [15].

Conclusions
Florence Nightingale had an enormous contribution
to the development of health care. She is indeed the founder
of modern scientifically based nursing. Her achievement
should be better reflected and disseminated by historians
of medicine.

References
1. David L, Farcau D, Dumitrascu DL, Rogozea L. Florence
Nightingale (1820-1910), the founder of nursing, at the
bicentenary. Brasov Med J. 2019;2:72-77.
Figure 2. Stamp issued by United Nations Vienna office on 12
May 2020. 2. Karimi H, Masoudi Alavi N. Florence Nightingale: The
Mother of Nursing. Nurs Midwifery Stud. 2015;4:e29475.
3. Nightingale F. Cassandra: an essay. 1979. Am J Public
The Florence Nightingale Museum in London Health. 2010;100:1586-1587.
contributes to the perpetuation of the personality and 4. Hedwig Herold-Schmidt: Florence Nightingale. Die Frau
achievement of Florence Nightingale. Figure 3 represents hinter der Legende [The woman behind the legend],
a painting from this Museum (published with the kind Darmstadt: wbg Thesis 2020.
permission of the Museum director). 5. Bostridge M. Florence Nightingale. Penguin Books, London;
2009.
6. Small H. A brief history of Florence Nightingale. Little
Brown Book Group; 2017.
7. Chang TF. Creolizing the white woman’s burden: Mary
Seacole playing “mother” at the colonial crossroads between
Panama and Crimea, Johns Hopkins Univ Press; 2017.
8. Cruse P. Florence Nightingale. J Amer Coll Surg
1980;88:394-399.
9. Fee E, Garofalo ME. Florence Nightingale and the Crimean
War. Am J Publ Health 2010;100:1591.
10. Anderson RJ. Florence Nightingale: the biostatistician. Mol
Interv. 2011;11:63-71.
11. Grill E, Müller M. The ICF and Florence Nightingale
- bringing data to statistical proof. J Rehabil Med.
2011;43:1041-1042.
12. Wallace DJ, Kahn JM. Florence Nightingale and the
Conundrum of Counting ICU Beds. Crit Care Med.
Figure 3. Nursing activity of Florence Nightingale in Scutari 2015;43:2517-2518.
Hospital (Florence Nightingale Museum, photograph 2019; with
permission of the Museum). 13. Schmalbach CE. Patient Safety/Quality Improvement (PS/
QI): Florence Nightingale prevails. Otolaryngol Head Neck
Surg. 2015;152:771-773.
Echoes of Florence Nightingale’s activity in 14. Ellis H. Florence Nightingale: nurse and public health officer.
Anniversary. Bull Hosp Medicine. 2010;71:71.
Romania
Most scholars of the history of medicine are 15. Ionescu C, Dinu EA, Ercze A, Dobrescu C, Rogozea L,
Nemet C. De la infecția nosocomială la infecția asociată
familiar in Romania with this name. However, not many
actului medical din perspectivă istorică [From nosocomial
know in detail her biography. Unfortunately, there are no infection to medical-act-related infection from a historical
monographs dedicated to her to our knowledge. perspective]. Brasov Med J. 2019;1:4-8.

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