Florence Nightingale: Relevant as today's news

Eight years and one week ago today was a special day at the Florence Nightingale Museum in London. (Today is the 104th anniversary of her death.*) At a press event, we unveiled an extraordinary discovery, a previously unknown photograph of Florence Nightingale. To put this in perspective, Nightingale was so reclusive that barely more than two dozen known portraits of her are known to exist, despite the fact that photography was invented and came into fashion during her lifetime. In my 18 years with the museum, we often received prints—and even some original artwork—based on the few long-known Nightingale portraits. To put the discovery in perspective, although the National Portrait Gallery in London opened just after the Crimean War to serve the public interest in portraits of great Britons, it took many years for the gallery to acquire its first original portrait of Nightingale.

So the scarcity-induced value of the newly discovered photograph made August 6, 2006, a very exciting day for all involved in the museum. The photograph was taken around 1858 by William Slater, a pharmacist who lived and worked close to the Nightingale family home in Hampshire, in the south of England. Hidden away until after the death of a direct descendent of Slater, the photograph was donated to the museum by generous beneficiaries.

Reproduced by courtesy of the Florence Nightingale Museum Trust, London

At the time, I apprised the press on how new and fresh the photograph was—that it showed Florence Nightingale in an informal and relaxed setting, very different from the slightly austere post-Crimean studio images we had become accustomed to. It is a contemplative image. Nightingale is reading a book in the garden of her home at Embley Park, under the shade of a tree. A private note she wrote two decades previously, at the age of 16, revealed to posterity that it was there she had her first “call from God.” It was not yet apparent that her calling was to become a nurse, but as she gathered information, it gradually dawned upon her, and her calling became so strong that she was able to overcome the barrier of social stigma faced by aristocratic Victorian women and, as a result of her nursing work in the Crimean War, forged a new profession.

I found it quite remarkable that such a candid image could suddenly appear without us having known about it previously. Mark Bostridge, author of the then-recently published Penguin biography Florence Nightingale: The Woman and Her Legend—the photo graces the book’s front cover—had been involved in identifying the photograph and had spoken with its inheritors. About the lack of Nightingale portraits, Bostridge observed, “She regarded any personal publicity as detrimental to the causes of public health for which she worked so tirelessly after her return from the Crimean war.”

To our surprise and delight, the image was syndicated and the story of its discovery published across the world—from Zimbabwe to China. A thumbnail of the image appeared on the front page of The Guardian newspaper in England with a longer story inside. In the print edition of the paper, the story was published alongside news about a series of rocket attacks on northern Israel—“Israel’s bloodiest day yet as Hezbollah hits troops and Haifa.”

I discussed the juxtaposition of the Nightingale story with the report of conflict in the Middle East with Sir Robert Crawford, a museum trustee and then-director of the Imperial War Museum.** The juxtaposition was fitting, he observed, in light of the fact that, nearly 150 years earlier, Nightingale’s rise to fame had resulted from the effort that she and her nurses had brought to alleviate suffering of wounded soldiers.

Eight years to the day after the long-delayed unveiling of Nightingale’s photograph to the public, I began writing this post in a café in Antigua, Guatemala. Over coffee, I struck up a conversation with David, a young Swiss student on his travels, and talk turned to Florence Nightingale. He had not heard of her, he said, but he did tell me about some research he had done at school on the origins of the Red Cross. The Red Cross emblem, positioned on a white field, originated at the First Geneva Convention in 1864 and is the inverse of Switzerland’s flag, which has a white cross on a red background. As such, it is a tribute both to Henry Dunant, founder of the International Committee of the Red Cross, and the principle of neutrality in war, of which the Swiss nation has long been proud.

Dunant had witnessed the horrors of war firsthand in Italy, where, in 1859, he observed the aftermath of the Battle of Solferino. In a book he wrote about his experiences, published eight years after the Crimean War, he cited the example of Florence Nightingale as a principle inspiration for his humanitarian work in wartime, and the International Committee of the Red Cross was created shortly afterward, in 1864.

Returning to my temporary home in Antigua, I looked up the latest information on the Red Cross and the Red Crescent and found the following tweets by Peter Maurer, president of the International Committee of the Red Cross (ICRC), which he made during a three-day visit to Gaza: 1) “I have a deep feeling of shock at what I’ve seen and anger that we weren’t able to prevent what has happened.” 2) “I was shattered to see the human impact of the conflict in #Gaza. I was angered and felt compassion for all those that lost loved ones.”

Today, eight years after the unveiling of the Nightingale photograph, conflict in the Middle East continues. I regard this post as an opportunity to pay tribute to courageous and skillful nurses, on both sides of the conflict, who are responsible for saving countless lives and are helping to begin the long and painful process of healing, one person at a time.

By the way, this October, members of the Honor Society of Nursing, Sigma Theta Tau International from Indianapolis, Indiana, USA, join me on a Florence Nightingale tour to England, where we will visit her homes, including Embley Park, where the photograph was taken.

* Coincidentally, today is my 50th birthday. I am half the age of my grandmother, Hilda Austin, who celebrated her 100th in April. One of the greatest inspirations in my life, she was a nurse in England, and I dedicated my STTI-published book, Illuminating Florence, to her. Grandmother Hilda was born in 1914, the year the First World War broke out and the subject of Mark Bostridge’s latest book, The Fateful Year. He is, of course, also the latest biographer of Florence Nightingale. As you can see, I have a love for and a fascination about resonant dates.

** The Imperial War Museum, established as the first museum of peace, documented exhaustive details about suffering inflicted during the First World War, in the hope that such a conflict would never again occur. The war, which began 100 years ago this year, was so terrible that it was said to be “the war to end all wars.”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Nightingale and the Great British Cup of Tea, Part Two

As I was saying before having my cuppa (see previous post), we can find the same principle at work when we look at that beverage. (To refresh your memory, the principle to which I’m referring is that a remedy under one set of circumstances might not apply under other circumstances.) A case in point can be found in the Project Gutenberg online version of Florence Nightingale’s Notes on Nursing (1860). Here is the quote in question: “… it is however certain that there is nothing yet discovered which is a substitute to the English patient for his cup of tea; he can take it when he can take nothing else, and he often can’t take anything else if he has it not.”

The key point here is not the wonderful effect of tea per se, but the effect Nightingale notices in terms of, specifically, English patients. To interpret this, we need more information. Nightingale wrote this in 1859, and it was published in 1860. During the previous decade, she had ample firsthand nursing experience with English and non-English patients. She wrote Notes on Nursing for English people. She did not anticipate foreign translations, of which there have been more than 10. Evidence for this is that, in correspondence with her publisher, no mention is made of translations. By saying “the English patient,” Nightingale is clearly implying that, during illness, people of other nationalities do not find tea to be such an important drink. My point here is not to analyze in detail specific properties of tea, but rather to observe that British people react to tea differently than other nationalities, something Nightingale clearly understood.

Tea has been used as a “rescue” drink by British people for generations. Nightingale thought its powers were a bit exaggerated. These are her words: “When you see the natural and almost universal craving in English sick for their ‘tea,’ you cannot but feel that nature knows what she is about. But a little tea or coffee restores them quite as much as a great deal, and a great deal of tea and especially of coffee impairs the little power of digestion they have.”

If you are British, tea is something you understand naturally. There are, broadly, two sorts of tea drunk in England: builder’s tea and fine—or “posh”—teas, such as Earl Grey. Both are essentially black tea. The former, orangey in color, is cheaper and is drunk invariably with milk and sugar. When the Normandy landings took place in World War II, the British, after fighting on the beaches, stopped to brew tea. The American response was a sense of shock at British eccentricity, as if the Brits were stopping to drink posh tea at 5 p.m., rather than continue fighting. I think it would be obvious to any Brit that Tommy Smith would be drinking builder’s tea out of a sense of sheer bloody necessity, and I believe this is essentially what Florence Nightingale was talking about.

Tea remains something of an in joke in British culture to this day, to the extent that it was featured in the cult comedy-horror film “Shaun of the Dead,” which made it into Quentin Tarantino’s list of top 10 films of the ’90s. In this film, the protagonist’s stepfather is turning into a zombie, so his family’s response is to go home and have a cup of tea.

I have come across many personal anecdotes of nurses giving tea to patients in moments of crisis. In the public domain, my favorite, from the Victoria Wood’s 2013 BBC documentary “A Nice Cup of Tea” (second of the two), is an interview with a World War II volunteer nurse. Incidentally, Wood noted with some nostalgia that the younger generation of British people rarely has time to fit tea drinking into their day, so perhaps that great and honorable tradition is finally dying off. Now would be a good time, therefore, to understand what tea means to patients, before the tea-drinking tradition finally vanishes—in England, at least.

In summary, the case I am making is not so much about tea, specifically. The point is, there are some things that work for certain groups of patients and not others. I would have expected Nightingale to pick up on something so culturally significant for my home country as tea. And she did. What we can learn from this is that an understanding of cultures and diversity can provide nurses with a key to better patient care.

Who would imagine how much an Argentine patient, sick in hospital abroad, would be lifted by being offered a cup of hierba mate? On the other hand, when I worked at the Florence Nightingale Museum in the London borough of Lambeth, I was aware that 147 languages, apart from English, were spoken there. I would be challenged to name a quarter of them, despite the fact that I am a historian and linguist. Cultural diversity must also be an immense challenge for nursing. Tea is an interesting starting point for this important discussion.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Tweeting Nightingale, Part One

Years ago, I had a chat with an eminent and charismatic British nursing historian, the late Monica E. Baly, PhD, RGN, about a controversy in the press over the discovery of some Florence Nightingale letters. I’d expected Baly to have a critical insight, but still she surprised me with her reaction. “Froth” she said, as she made a dismissive hand gesture. I was too taken aback to argue, but I could have taken the line of one of my university professors, John Vincent, who said that newspapers are one of a historian’s best sources of information.

So what on earth would Baly make of Twitter? Why should we take Twitter seriously? It’s interesting, up-to-date, surprising, diverse, and humorous—sometimes several of these at the same time—and, by the way, the spelling is horrible.

I would venture that the qualities I mention here make Twitter an ideal source of cultural information. I have no idea how well Twitter is being archived; it’s only six years old, and it may be too soon to say. But I have no doubt that future nursing historians will find it very useful, apart from the spelling mistakes and the errors that come from repetition. In Part Two of this post, to follow a few days from now, I focus on a case in point, a Florence Nightingale quote.

Alex’s top five Florence Nightingale tweets

Admittedly, I had rather too much time on my hands while ill last week. Trawling through old tweets, I collected a medley of them to illustrate my point.

Tweet 1: I actually found out something new about Florence Nightingale, thanks to a tweet posted by @mryap with a link to a video about Florence Nightingale’s important contribution to statistics. At 1:03 on the video, you can see some basic statistical tables drawn up by Florence as a 9-year-old child. It’s enlightening to see this early evidence of what became one of Nightingale’s most important achievements, the pioneering of data visualization.

Tweet 2: I find Twitter endlessly fascinating for the insights the medium’s users provide into the evolving gender politics of nursing. The tweet by @overmanlymurse—“Florence Nightingale? Never heard if [sic] him”—uses humor to pose an interesting question about the relevance of Nightingale to the new breed of male nurses who identify themselves as “murses.”

Tweet 3: I am a student of images of Florence Nightingale, so I was surprised to discover an entirely new category of image—Florence Nightingale tattoos—in a tweet received by @Tatted_Nurse. For your information, the tattoo image is based on the 1856 photograph of Nightingale that was commissioned by Queen Victoria after the former’s return from the Crimean War.

Tweet 4: I had previously read about the so-called Florence Nightingale-Mary Seacole controversy (the Twitter link is to Seacole’s online autobiography), but reading tweets convinced me that the controversy is something like a Punch and Judy show, where two personalities are made to fight for the amusement of the crowd. This cartoon by Kate Beaton, @beatonna on Twitter, perfectly captures the essence of a Punch and Judy show, while utterly failing to represent historical facts. If Twitter comments are anything to judge by, nurses do not view the controversy as a big deal. Neither do I. For the record, I made a donation to the Seacole statue appeal years ago, and I see no conflict inherent in celebrating the achievements of both women.

Tweet 5: Finally, I end with a charming anagram of Florence Nightingale, tweeted by @zeniusenglish, a language school in Jakarta. Instead of highlighting a tweet on Nightingale in German, Spanish or Japanese, which are among the most popular languages in which to tweet Nightingale (so far as I can tell), I have chosen a tweet in Indonesian, which shows that Florence Nightingale represents not just the English nation, but the English language as a whole to the non-English speaking world. Oh, and here is the anagram: “flit on cheering angel.”

You can find the original tweets among the "favorites” on my Twitter profile at @alexattewell. And remember to watch for Part Two of "Tweeting Nightingale," coming soon!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Still lighting the way

It’s around 90 degrees but with a refreshing breeze as I sit at my desk, looking out over an expanse of fresh water of the Laguna Bacalar. I hear continuous bird chatter, mainly gentle and melodious, interspersed with the racket of chachalacas and the occasional squawks of passing green parrots. I am keeping my eye on a pair of attractive orange-hooded orioles nesting nearby. Here in tropical Mexico, London, my home town, seems a long, long way away. But I picture perfectly the scene unfolding in Westminster Abbey as the annual Florence Nightingale Commemoration Service gets under way.

Westminster Abbey, site of annual Florence Nightingale
Commemoration Service.

The atmosphere of the Abbey is something else when it is full of nurses; it feels almost tangible. There is something calming about the feel of the space and the smell of the ancient stone but, once a year, when it is full of nurses, a palpable excitement rises as the organ music begins and the procession makes its way through the nave.

As I am so far away, I can only imagine the scene, but today I had the privilege of receiving this year’s Abbey address from the speaker, Mark Bostridge, whose major biography Florence Nightingale: The Making of an Icon was published five years ago. I have known Mark for many years and was fortunate to help him in the process of his research. His words from the Abbey address seem typical of him, at once eloquent, understated, and based on deep scholarship and awareness of his audience.

He starts by telling how an infirm Florence Nightingale came to sit in Westminster Abbey in 1879 for a memorial service to one of her heroes, Sir John Lawrence, who was her ally in health promotion in India, and he goes on to talk about how Nightingale herself has been hero-worshipped. During the course of his address, he cites many reasons why Nightingale is still relevant in terms of the organization of health care, the design of hospitals, the clarity of her vision and expression, the importance of nurses speaking out to ensure the safety of their patients (which Nightingale would have supported), and the continuing relevance of nursing as an art.

I was particularly struck by the manner in which Mark Bostridge distinguished between the myth and the continuing value of Nightingale’s legacy, as he shine the light of the mythical lamp back on the nurses assembled in the Abbey’s nave and the choir: “In a moment, you will watch the time-honoured tradition of a lamp, representing the one used by Nightingale at Scutari, being processed to the High Altar. We don’t, in fact, know whether Florence Nightingale attached much importance to the system of lighting she employed at her hospital during the Crimean War, though, of course, it cemented her popular image as the Lady with the Lamp. But I’d ask you this evening to look at that lamp, not as a symbol perpetuating a simplistic, outdated legend, but as an image of the best of modern nursing, shining the light of humanity into some of the darker and lonelier corners of human experience.”

At that point, David Wright, a lead nurse in the cancer service for teenagers at Christie Hospital in Manchester, proceeded to carry the gleaming genie-style lamp to the altar, escorted by a group of student nurses from De Montfort University in Leicester. I am sure the experience will be a great boost to their professional careers, 158 years after Florence Nightingale carried the cylindrical Turkish lantern in the wards of the Barrack Hospital at Uskudar in Istambul.

The service ends with the uplifting sounds of the organ and, as the people leave the Abbey, they may brush shoulders with Florence Nightingale’s closest living relative or this year’s British nurse of the year. There follows 10 minutes of the most intense professional networking you can imagine. I don’t think there is an iPhone app capable of keeping pace with the rapid and impromptu meetings and exchanges; it is a once-a-year experience for many fortunate senior nurses and a once-in-a-lifetime experience for nurses who have come from across the globe.

The service is organized by The Florence Nightingale Foundation, the purpose of which is to support nurses and midwives through scholarships and mentoring. As you can see from the symbolic roles in the Abbey service, the foundation also has a key role in promoting pride in nursing and recognizing the work of practicing nurses. The foundation is now a stand-alone organization, but its origins are in the National Florence Nightingale Memorial Committee for Great Britain and, more than 80 years ago, similar national committees in countries across the world were linked to the Florence Nightingale International Foundation (FNIF) in Geneva. The FNIF is still very much in existence under the umbrella of the International Council of Nurses.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.