Florence Nightingale - Later Career

Later Career

In the Crimea on 29 November 1855, the Nightingale Fund was established for the training of nurses during a public meeting to recognize Nightingale for her work in the war. There was an outpouring of generous donations. Sidney Herbert served as honourary secretary of the fund and the Duke of Cambridge was chairman. Nightingale was considered a pioneer in the concept of medical tourism as well, based on her 1856 letters describing spas in the Ottoman Empire. She detailed the health conditions, physical descriptions, dietary information, and other vital details of patients whom she directed there. The treatment there was significantly less expensive than in Switzerland.

Nightingale had £45,000 at her disposal from the Nightingale Fund to set up the Nightingale Training School at St. Thomas' Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. Now called the Florence Nightingale School of Nursing and Midwifery, the school is part of King's College London. She also campaigned and raised funds for the Royal Buckinghamshire Hospital in Aylesbury near her family home.

Nightingale wrote Notes on Nursing (1859). The book served as the cornerstone of the curriculum at the Nightingale School and other nursing schools, though it was written specifically for the education of those nursing at home. Nightingale wrote "Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognised as the knowledge which every one ought to have – distinct from medical knowledge, which only a profession can have".

Notes on Nursing also sold well to the general reading public and is considered a classic introduction to nursing. Nightingale spent the rest of her life promoting and organizing the nursing profession. In the introduction to the 1974 edition, Joan Quixley of the Nightingale School of Nursing wrote: "The book was the first of its kind ever to be written. It appeared at a time when the simple rules of health were only beginning to be known, when its topics were of vital importance not only for the well-being and recovery of patients, when hospitals were riddled with infection, when nurses were still mainly regarded as ignorant, uneducated persons. The book has, inevitably, its place in the history of nursing, for it was written by the founder of modern nursing".

As Mark Bostridge has recently demonstrated, one of Nightingale's signal achievements was the introduction of trained nurses into the workhouse system in England and Ireland from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff.

Though Nightingale is sometimes said to have denied the theory of infection for her entire life, a recent biography disagrees, saying that she was simply opposed to a precursor of germ theory known as "contagionism". This theory held that diseases could only be transmitted by touch. Before the experiments of the mid-1860s by Pasteur and Lister, hardly anyone took germ theory seriously; even afterwards, many medical practitioners were unconvinced. Bostridge points out that in the early 1880s Nightingale wrote an article for a textbook in which she advocated strict precautions designed, she said, to kill germs. Nightingale's work served as an inspiration for nurses in the American Civil War. The Union government approached her for advice in organizing field medicine. Although her ideas met official resistance, they inspired the volunteer body of the United States Sanitary Commission.

In the 1870s, Nightingale mentored Linda Richards, "America's first trained nurse", and enabled her to return to the USA with adequate training and knowledge to establish high-quality nursing schools. Linda Richards went on to become a great nursing pioneer in the USA and Japan.

By 1882, several Nightingale nurses had become matrons at several leading hospitals, including, in London (St Mary's Hospital, Westminster Hospital, St Marylebone Workhouse Infirmary and the Hospital for Incurables at Putney) and throughout Britain (Royal Victoria Hospital, Netley; Edinburgh Royal Infirmary; Cumberland Infirmary and Liverpool Royal Infirmary), as well as at Sydney Hospital in New South Wales, Australia.

In 1883, Nightingale was awarded the Royal Red Cross by Queen Victoria. In 1904, she was appointed a Lady of Grace of the Order of St John (LGStJ). In 1907, she became the first woman to be awarded the Order of Merit. In the following year she was given the Honorary Freedom of the City of London. Her birthday is now celebrated as International CFS Awareness Day.

From 1857 onwards, Nightingale was intermittently bedridden and suffered from depression. A recent biography cites brucellosis and associated spondylitis as the cause. An alternative explanation for her depression is based on her discovery after the war that she had been mistaken about the reasons for the high death rate. There is, however, no documentary evidence to support this theory. Most authorities today accept that Nightingale suffered from a particularly extreme form of brucellosis, the effects of which only began to lift in the early 1880s. Despite her symptoms, she remained phenomenally productive in social reform. During her bedridden years, she also did pioneering work in the field of hospital planning, and her work propagated quickly across Britain and the world. Nightingale output slowed down considerably in her last decade, she now wrote very little due to blindness and declining mental abilities, though she still retained an interest in current affairs.