Florence Nightingale in the Crimean War: Scutari and After

In the autumn of 1854 British readers learned from their newspapers that sick and wounded soldiers from the Crimea were dying in filth, without basic supplies. Within weeks a 34-year-old woman with no military rank was on her way to the main British base hospital with a government appointment and a party of nurses. What Florence Nightingale did at Scutari, and what she did with the numbers afterward, made her the best known woman of the Crimean War. Her story also shows how quickly legend outgrows the record: the lamp is real, but so is the long argument among historians about how many lives she saved.

Who was Florence Nightingale before the war?

She was born on 12 May 1820 in Florence, Italy, and named after the city. Her family was wealthy and English, and life for a woman of her class was expected to mean marriage and society. Nightingale wanted work instead. She visited hospitals at home and abroad, spent part of 1851 training at the Protestant deaconess institute at Kaiserswerth in Germany, and in 1853 took her first management post, as superintendent of a small hospital for gentlewomen in Harley Street, London. At the time hospital nursing in Britain had a poor reputation and was seen as unskilled work.¹

Why did Nightingale go to Scutari?

Britain and France went to war with Russia in 1854 and landed an army in the Crimea that September. In October 1854 The Times, in reports from the East usually credited to its correspondent William Howard Russell, described the neglect of the sick and wounded and asked whether no British women would go out to nurse them. Sidney Herbert, the Secretary at War and a friend of hers, wrote to her on 15 October 1854 asking her to lead a party of female nurses, while she was writing to offer her services; the two letters crossed. Until then, as Herbert wrote, only men had been admitted as nurses to British military hospitals.²

The party left London on 21 October 1854: Nightingale and 38 nurses, a mix of Anglican and Roman Catholic sisters and paid hospital nurses. They traveled through France to Marseilles and on by steamer, reached Constantinople on 3 November and began work at Scutari on 4 November, the day before the Battle of Inkerman. Her official title was Superintendent of the Female Nurses in the Hospitals in the East, but she was usually called the Lady-in-Chief.³

The Barrack Hospital at Scutari

The Barrack Hospital was a huge Turkish army barracks lent to the British, a quadrangle on a hill above the Bosporus with miles of corridors. Inside, the nurses found overcrowding, dirt, rats and vermin, and a lack of almost everything: basins, soap, towels, hospital clothing and decent food. Many stores had been left at Varna in Bulgaria or lost at sea. Most of the patients were suffering from disease rather than battle wounds.⁴

The army doctors did not all welcome the women at first. Nightingale won ground by solving practical problems. With money from The Times fund and other donations she bought supplies, and she set up an invalid kitchen and a laundry. A second party of nurses, 46 by one count and about 50 by another, arrived around the turn of 1854 and 1855.⁵

Was she really the Lady with the Lamp?

The image comes from a report sent home in February 1855 by Mr. Macdonald, the man who handled The Times fund for the sick and wounded at Scutari. After the doctors had gone for the night, he wrote, she could be seen alone, “with a little lamp in her hand, making her solitary rounds”. Within months the scene was sold as a popular print, and in 1857 the American poet Henry Wadsworth Longfellow turned it into “a Lady with a Lamp” in his poem Santa Filomena.⁶

The night rounds were real, but the nickname covers only a small part of her job. Most of her day went on administration, purchasing and letters to London. In May 1855, while visiting hospitals near Balaclava in the Crimea, she fell dangerously ill with what was called Crimean fever, and afterward returned to Scutari. She stayed in the East until the summer of 1856, after the peace.⁷

Did Florence Nightingale lower the death rate at Scutari?

This is where the record is contested. The figures most often quoted say that the death rate among patients reached about 42 percent in February 1855, and one widely repeated account says it fell to about 2 percent by June. The historian Lynn McDonald, editor of the Collected Works of Florence Nightingale, points out that there are no separate figures for Nightingale’s own hospital: the official death rates combine several hospitals on the Bosporus, often reported together as the Scutari and Koulali hospitals, and Koulali was not under her superintendence. Citing the official army report, she notes that 11.9 percent of patients admitted to the Scutari hospitals died, against 25.9 percent at Koulali.⁸

The turning point came from outside the nursing staff. A Sanitary Commission led by Dr. John Sutherland began work in March 1855; it had the sewers repaired and the ventilation improved, and only then did mortality fall sharply. So how much credit belongs to Nightingale? In Florence Nightingale: Avenging Angel (1998), the writer Hugh Small argued that she had not understood during the war that bad sanitation was killing her patients, that she had officially rejected that explanation, and that discovering the truth afterward devastated her. McDonald rejects this: she says Small offered no tables of figures, compared unlike groups of hospitals, and overlooked the fact that in her report Nightingale repeatedly named Koulali as the worst of the hospitals and in her letters blamed the army’s principal medical officer, Sir John Hall, not herself. What both sides accept is that the drains, not the lamp, made the biggest difference, and that Nightingale became the most effective campaigner for that lesson.⁹

Statistics and the rose diagram

Back in England in 1856, Nightingale turned to evidence. A Royal Commission on the health of the army, driven by Sidney Herbert, took evidence in 1857 and published its report in 1858; Nightingale supplied much of the statistical case. Working with the medical statistician William Farr, she prepared her own long confidential report, Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army (1858).¹⁰

Its best known page is the polar-area chart now called the rose or coxcomb diagram. Each of twelve wedges is a month; its area shows how many soldiers died, with blue for preventable infectious disease, red for wounds and black for other causes. Set side by side, the two years show at a glance that disease, not the enemy, killed most British soldiers in the East, and that deaths fell after the sanitary reforms of spring 1855. She became the first woman fellow of what is now the Royal Statistical Society.¹¹

Mary Seacole, a contemporary

Nightingale was not the only woman known for caring for British soldiers in this war. Mary Seacole, a Jamaican-born healer, applied in London to go out as a nurse and was turned down. She paid her own way to the Crimea in 1855 and, with her business partner Thomas Day, opened the British Hotel near Balaclava, which offered food, lodging and medicines to officers and soldiers. According to her own memoir, she stopped at Scutari on the way, met Nightingale, and was found a bed for the night in the washerwomen’s quarters. The two women worked in different places and in different ways, and Seacole’s memoir of 1857 became a bestseller. Comparing them as rivals tells us less than reading both records side by side.¹²

Legacy: how she is remembered

A public fund raised in her honor collected more than £40,000 (about £44,000 by the count in the hospital’s archive catalog), and Nightingale used it to open the Nightingale Training School for nurses at St Thomas’s Hospital in London on 9 July 1860. Her short book Notes on Nursing, which came out at the turn of 1859 and 1860, was read far beyond hospitals. She spent the rest of her life largely as an invalid at home in London, yet kept writing and advising on army, hospital and Indian sanitary reform. In 1907 she became the first woman appointed to the Order of Merit, and she died in London on 13 August 1910.¹³

Today nurses around the world mark International Nurses Day on 12 May, her birthday. Her name is often set beside the women who fought in history’s wars, but her weapons were different: a ward round, a supply list and a well-drawn chart. If you want the battles that filled her wards, read about the Battle of the Alma and the Battle of Balaclava.¹⁴