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Florence Nightingale
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THE LIBRARY
OF
THE UNIVERSITY
OF CALIFORNIA
LOS ANGELES
GIFT OF
DR. AND MRS. ELMER BELT
HEALTH HEROES
Florence
Nightingale
By
Grace T. Hallock, coauthor of
Growing Up, the Safe and Healthy
Living series, and other health books
and
C. E. Turner, Professor Emeritus of
Public Health, Massachusetts Insti'
tute of Technology.
Copyright, 1928, by
Grace T. Hallock and C. E. Turner
Grateful ac\nowledgment is made to
the following publishers for permis-'
sion to copy pictures:
The Macmillan Company for por'
trait of Florence Nightingale from
The Life of Florence Jiightingale,
Vol. I, by A. T. Cook, and for a
scene from Florence from A Wan^
derer in Florence by E. V. Lucas;
G. P. Putnam's Sons for pictures
from A History of A[ursmg by Nut'
TING and Dock; Underwood and
Underwood for picture of Florence
Nightingale as a young girl from
A Modern World Setting for Amer-
ican History by Jones and Sleman.
(Edition of January 1948)
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Florence
Nightingale
1520-1910
LITTLE more than 100 years ago, a wealthy
Englishman and his wife were traveling in
Italy. Europe had then become safe for trav-
elers because the wars of Napoleon had come
to an end at last. In 1820, this couple, Mr. and Mrs.
William Nightingale, and their little daughter. Par-
THENOPE, were in the city of Florence. There, on May
12, another daughter was born to the Nightingales.
She was named for her birthplace. Thirty-four years later
the whole world was to hear the name of Florence
Nightingale.
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From the time she was 5 years old Florence had two
homes in England. One was Lea Hurst, near the quaint
village of Lea in Derbyshire. The other was Embley Park,
near Romsey, on the edge of the New Forest.
Both homes were surrounded with beautiful old trees
and flower gardens. Florence loved flowers and birds
and animals. She loved babies, too, and although there
were none in her own family, she had a great many little
cousins in whose teethings and baby illnesses she was
greatly interested.
The City of Florence,
birthplace of Florence Nightingale
ft '^
^4^^^^
HEALTH HEROES— FLORENCE NIGHTINGALE
Florence Nightingale
at 8 years of age
Education
Florence was given a better
education than was at that time
thought suitable for young ladies.
To be sure, she and her sister learned
. all the usual female accomplish-
Jk. «^ . ments. They were taught to use a
\ 1 1 \ globe, to copy out ''elegant ab-
T\ J stracts'' from various writers, to em-
/ / ^^ broider slippers and footstools, and
\ ' tf'^"'^^^"""^ to do other fancy work. They
|. studied music, grammar, composi-
^ tion and modern languages. Mr.
Nightingale himself added to this
learning by teaching his daughters
Latin, Greek, mathematics and history.
Florence was a good student and a quick one.
By the time she was 17, she had read a truly formidable
list of books in both modern and ancient languages. Her
father had trained her to think clearly and to concentrate
her mind on what she had to do. This training was to
help her greatly in later years when quick, clear thinking
meant the saving of lives. Florence was taught, as well,
the usual manners and graces, which prepared her to take
her place in the social world. She and her sister spent
a season abroad and were then presented at court.
Florence was not beautiful, but she possessed charm and
distinction, and was a good, even a witty talker.
5
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Unhappiness
Although Florence's life was full and busy, both in
London and at the country houses of her family and
friends, she was not happy. The occupations of a young
lady of fashion could not satisfy her keen mind and un-
bounded energy. The first record we have of her desire
to become a nurse is found in a conversation which she
had with the husband of Julia Ward Howe. In 1844,
Dr. and Mrs. Howe were staying with the Nightingales
at Embley. Florence said to Dr. Howe: "If I should
determine to study nursing, and to devote my life to that
profession, do you think it would be a dreadful thing?''
Dr. Howe replied: ""Not a dreadful thing at all. I
think It would be a very good thing.''
But to Florence's parents and sister it did seem a
dreadful thing. In every way possible they tried to turn
Florence from her idea. But so definite was that idea
that, shortly after her talk with Dr. Howe, the freedom
to nurse sick people became Florence Nightingale's
strongest desire.
It is hard for us today to visualise what nursing was
like in the first half of the nineteenth century. Many
nurses were untrained, coarse, ignorant women. Some-
times they were actually cruel to their patients. As a
result, most hospitals in England, Scotland and Ireland
were places of dirt and misery and needless suffering.
Florence's family felt that they could not allow her to go
into such conditions as these.
She was bitterly disappointed when her mother re-
fused to let her enter a hospital for training. To distract
her mind, her family sent her abroad with friends. Wher-
ever she went she visited hospitals and learned what she
could of organisation and methods of nursing.
HEALTH HEROES— FLORENCE NIGHTINGALE
Happiness
At this point in the life of Florence Nightingale
came the first test of the quality of her determination.
Persistence met opposition and conquered. Vain were
the attempts of Florence's family to lure her from her
purpose by offering the distractions of travel and the
gayeties of social life. In 1851, she entered the Deaconess
School at Kaiserwerth in Germany for a short term of
training as a nurse. The life there was hard and bleak,
but Florence Nightingale gloried in it. She wrote her
mother: ''This is Life! I wish for no other earth, no
other world but this.''
After this beginning there was no holding Florence
Nightingale back. She had started toward the realizia-
tion of her desire. It was to be a long, hard way, but her
persistence was not to be denied.
In 1853, Florence Nightingale took her first ''situa-
tion." She became the Superintendent of an Establish-
ment for Gentlewomen During Illness, in London. The
fact that her patients were to be " gentlewomen" partly
reconciled her family, but, even so, her mother did not
understand her. With tears in her eyes, Mrs. Nightin-
gale said:" We
are ducks and
have hatched a
wild swan."
The Kaiserwerth
Training School,
Germany
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Map showing seat of war
Outbreak of the Crimean War
Florence Nightingale had been a year in her
situation when, in 1854, the Crimean War broke out.
Russia, with an eye on Constantinople, had seized some
Turkish provinces on the Danube. This did not suit
France and England, as it threatened their interests in the
East. They joined Turkey in a war on Russia, and the
battleground was the Crimea, a small peninsula thrust
out into the Black Sea. There the fleets of the allied
powers landed their troops, and there, in September, 1854,
was fought the first great battle of the war, the battle of
the Alma River. The allies were victorious and England
went wild with joy.
The Call
But the rejoicing quickly changed to mourning. The
number of the killed and wounded was very large and
presently charges of neglect toward the sick and wounded
in the military hospital at Scutari were published in a
London newspaper. There was one woman in England
who was ready, experienced in nursing, and anxious to
HEALTH HEROES— FLORENCE NIGHTINGALE
serve, who could come to England's help in this hour of
desperate need. Fortunately there was one Englishman
who knew it. Their letters to each other crossed in the
mail. One letter was from Florence Nightingale offer-
ing to go to the Crimea with a party of nurses. The
other was from her friend, Sidney Herbert, the Secretary
of War, asking her to go.
Within five days from the time that each one had
accepted the other's offer, Florence Nightingale, with
a party of thirty-eight nurses, was on her way to Scutari,
the place opposite Constantinople where the military
hospitals were located. She left in a great burst of en-
thusiasm. This Florence Nightingale, of whom most
people had never heard five days before, had become a
popular heroine.
At Marseilles, Florence Nightingale laid in a large
stock of supplies. She did this in spite of the fact that she
had been assured at the War Office that nothing was
needed for the comfort of the wounded soldiers. She and
her nurses arrived at Scutari on November 4, 1854, ten
days after the battle of Balaklava, and the day before the
battle of Inkerman. They were given quarters in one
tower of the Barrack Hospital, the chief hospital used in
the Crimean War.
The Military Hospitals
Dark as the picture of conditions in the military
hospitals had been painted in newspaper reports, the
reality turned out to be darker still. Florence Nightin-
gale had longed for a job equal to her ability and energy.
Now she had one. Her tidy mind and her capable fingers
had always itched to straighten out messes of any kind.
Now, in the hospitals at Scutari, she found a huge muddle
complicated by entangling red tape. In her own words.
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she found ''The sanitary conditions of the hospitals of
Scutari were inferior m point of crowding, ventilation,
drainage, and cleanliness to any civil hospital, or to the
poorest homes m the worst parts of the civil population
of any large town that I have seen/' Ordinary comforts
for the sick and wounded were lacking and necessary
surgical and medical supplies were often not forthcoming.
There were not enough beds, ''there were no vessels for
Military Hospital,
Scutari
water, or utensils of any kind; no soap, no towels or
cloths; no hospital clothes; no chairs, tables, benches, nor
any other lamp or candlestick but a bottle.'' Often the
wounded men were left lying in the uniforms they had
worn on the battlefield.
It was evident that there had been a complete break-
down of medical arrangements at the seat of war. No one
person could, or would, assume responsibility for this
awful failure. It was not the time to exclaim, "What a
mess!" nor to ask, "Whose fault is it?" That could come
later. The only thing that mattered then was: Here is a
job to be done. Florence Nightingale knew, of course,
that her position was a delicate one. Women nurses in an
10
HEALTH HEROES— FLORENCE NIGHTINGALE
army hospital were unheard of and the prejudices of both
the medical and military authorities must be overcome.
She made a good impression on most of the medical
men from the beginning. She was an expert and they were
quick to realise it. She obeyed rules and maintained a
rigid discipline over her nurses. She never lost her
temper, she never raised her voice, she was never over^
bearing, and so she won confidence.
The Emergency
The wounded from the battle of Balaklava began to
arrive shortly after the party of nurses landed. In the
Barrack hospital alone there were four miles of wounded
soldiers laid not eighteen inches apart. The wounded lay
up to the very door of the nurses' quarters. Florence
Nightingale wrote home: ''Let no lady come out here
who is not used to fatigue and privation,'' She herself
was known to be on her feet for twenty hours at a time.
Along with the permanent reform which Florence
Nightingale made with patient persistence came this
necessity for meeting emergencies.
Cleanliness
During the Crimean War, no one dreamed that in-
fections after surgical operations, or after wounds re-
ceived in battle, were caused by tiny living organisms. It
was not until twenty years later that Lister introduced
antiseptic methods in surgery by making practical use of
the germ theory of infection taught by Pasteur. But
Florence Nightingale did know that efficient nursing
demands cleanliness. She set herself to supply this neces-
sity. She found ''not a basin, nor a towel, nor a bit of
soap, nor a broom," in the whole place. One of the first
things she asked for was a supply of sacking and 200 hard
scrub-brushes for washing the floors.
II
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Up to the time of her arrival the largest number
of shirts washed in a month had been six. Florence
Nightingale installed a laundry at once and employed
in it the wives who had followed their soldier husbands
to the front.
Cooking
After starting her clean-up campaign, the next thing
that Florence Nightingale did was to install ''extra
diet'' kitchens with the supplies she had laid in at Mar-
seilles. Gone at last were the days when sick and almost
famished men found themselves confronted with hunks
of meat or bone or gristle from the thirteen copper kettles
in which all the food for the hospital had been cooked.
Now the meals were well prepared and served on time
and there were delicate jellies and broths to be had when
the doctors ordered them for their patients.
Storekeeping
Florence Nightingale set up a shop in a kitchen in
her tower. She was the storekeeper, the doctors were
the customers, and the patients the consumers. The
medical officers found that they could get from Florence
Nightingale necessary supplies which they could not
possibly procure from the official purveyor of the army.
But Miss Nightingale's stores could not last for-
ever. As soon as matters were somewhat straightened
out at the hospital, she set to work to unwind the red
tape in which the official stores sent out from England
were hopelessly entangled. Articles from the official
stores were supplied to the hospitals by the Purveyor
only on the requisition of a medical officer. The Pur-
veyor would not unpack goods until they had been
examined by the Board of Survey. This elaborate system
led to delays which maddened Florence Nightingale.
12
HEALTH HEROES— FLORENCE NIGHTINGALE
British private
soldiers in the
Crimean War
Once she ordered a government consignment to be
opened forcibly while the Purveyor stood by wringing
his hands in fear of what the Board would say. Some-
times she got the Board together herself and forced it to
''sit'' on supplies which were needed at once. She did
not take the report of others as to what was in the store-
house, but went foraging there herself.
More often than not what she wanted was not there.
Quantities of stores sent from England lay in the Turkish
Custom House. Supplies for the hospitals, loaded under-
neath the cargoes of shot and shell, were sometimes car-
ried to and fro three times over the Black Sea before
being landed at Scutari. Florence Nightingale saw that
the whole system was at fault, and, six months after her
arrival, she succeeded in having established, at Scutari, a
storehouse for the reception and distribution of supplies.
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The Ministering Angel
The military surgeons, the orderlies, her own nurses,
the Purveyor, saw in Florence Nightingale the ''im-
pelling power of a brain and a wilP' set to bring order out
of the chaos in the military hospitals. But to the sick and
wounded and to the public at home, she was known as the
Angel of the Crimea. At night when the medical officers
had gone to bed and darkness and silence had settled down
on those miles of prostrate sick, she might be seen, alone
with a lamp in her hand, making her solitary rounds. One
boy wrote home in a letter which became famous :
What a comfort it was to see her pass, even. She would
speak to one and nod and smile to as many more ; but she could
not do it all, you know. We lay there by hundreds, but we
could kiss her shadow as it fell, and lay our heads on the pillow
again content.
The men adored her. They saluted her as she passed
down the wounded ranks. ''Before she came,'' said one
soldier, "there was cussin' and s wearing but after that it
was 'oly as a church.'' Another, who had lost a leg at the
Alma River said, "If the Queen came for to die, they
ought to make her Queen, and I think they would."
They wrote home for her. They saved their money
for her. They went through painful operations without a
murmur for her. She called them "her children," and the
dead to her became "the heroic dead."
With all her other duties, Florence Nightingale
carried on a huge correspondence. Late at night when the
hospital was in darkness, she sat at her small unpainted
table and wrote the dying messages of soldiers to their
relatives, long reports to ministers at home and to military
and medical officials at the seat of war. She filled page
after page with recommendations, suggestions, criticisms,
statistics, and storekeeping accounts.
14
HEALTH HEROES— FLORENCE NIGHTINGALE
Results
Six months after Florence Nightingale's arrival, the
results of her activity were clearly apparent. Order and
cleanliness reigned in the wards. The hospitals were
better supplied. Sanitary improvements, so important
that Florence Nightingale said they had saved the
British Army, had been carried out. Most remarkable
of all, the death rate among the cases treated had fallen
progressively from 420 a thousand in February, 1855, to
twentytwo a thousand in June, 1855.
The Lady
of the Lamp
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In the Crimea
Not content with reforms at the hospital base,
Florence Nightingale now set out to inspect hospitals
at the seat of war. She made her first visit to the Crimea
in May 1855. Shortly after her arrival, she came down
with what was called Crimean fever. Even then, although
she could not walk, she could write, and write she did,
until she became delirious. When, after many weeks, she
was well enough to be moved, she refused to return to
England. ''I am ready to stand out the war with any
man,'' she said.
On September 8, 1855, Sebastopol fell. From this
date until the end of the war, Florence Nightingale
divided her time between Scutari and Crimea. In the
Crimea the work was very hard. She spent whole days
in the saddle, or was driven in a baggage cart over bleak
and rocky roads. She stood for hours in the heavily
falling snow. Often she did not reach her hut until late
at night after walking for miles through perilous ravines.
At last the war came to an end. Peace was signed in
Paris on March 30, 1856. Four months later Florence
Nightingale sailed for England.
At Scutari
16
HEALTH HEROES— FLORENCE NIGHTINGALE
Florence Nightingale
The Heroine
During Florence Nightingale's illness in the Crimea,
all England had held its breath.
When the bells were ringing ''Victory!'' after the
fall of Sebastopol, the name of Florence Nightingale
was on every tongue. Now that she was coming home, a
rousing welcome was planned for her. She was to be
transported on a man-of-war. Three military bands were
to meet her at the station and play her home whenever
she might arrive, by day or by night.
Florence Nightingale refused the man-of-war. On
August 7, 1856, a lady dressed in black entered the back
door at Lea Hurst. The old butler hastened to put her
out. She lifted her veil; it was Miss Florence. The
heroine had not chosen to publish her time of arrival.
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After the War
Florence Nightingale lived for more than half a
century after her return from the Crimea and m all that
time she practised the most rigid seclusion in order to
save strength for her work. The upper rooms of her house
in South Street, London, became the center of a network
of reform which spread over the world.
In the heyday of her usefulness she, a semi-invalid,
lay on her couch in her upper room, writing, writing,
writing. Below in the sitting-room, great statesmen,
famous generals, foreign royalties begged for audiences.
For many years, the newly appointed Viceroy to India
paid her a visit before leaving for his post. She had the
admiration of Queen Victoria, who had said when she
met Miss Nightingale, ''Such a head! I wish we had
her at the War Office.''
On her return from the Crimea, her friends begged her
to rest. Rest! How could she? She could never forget
the heroic dead. She could never forget that many of
her ''children'' were lying in their forgotten graves from
causes which might have been prevented.
Her experience in the Crimea, when it was happening,
had been her job. After it was over, it had become an
example. She said: "The sanitary history of the Crimean
campaign . . . is a complete example — history does not
afford its equal — of an army, after a great disaster arising
from neglects, having been brought into the highest state
of health and efficiency." Now was the time to drive
home the lesson of this example. With the help of Sidney
Herbert, she set out to reform the Army Medical
Service. She found that even in the army at home the
death rate was nearly double that of civil life. "You
might as well take i,ioo men every year out upon
Salisbury Plain and shoot them," she said grimly.
HEALTH HEROES— FLORENCE NIGHTINGALE
Sanitary Reform in the Army
She met stubborn opposition, but in the end she
forced the Minister of State for War to appoint a com-
mission to report upon the health of the army. She her-
self worked day and night to help the commission.
When the report was finished the next task was to
have its recommendations put into effect. In the end this
proved to be easy, as her friend, Sidney Herbert, became
Secretary of State for War. The army barracks were re-
modeled; the responsibilities and duties of Florence
Nightingale's old foe, the Purveyor, were accurately
defined. An Army Medical School was established, and
the Army Medical Department was reorganised on the
principle that it is as much a part of the duty of the
authorities to take care of the well soldier as it is to take
care of the sick soldier. By 1861, as a direct result of these
reforms, the death rate in the army at home had decreased
by one-half since the days of the Crimea.
Balmoral Castle
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Reorganization of Army Statistics
Another valuable service to the cause of army reform
was the emphasis which Florence Nightingale laid on
the reorgani2;ation of army statistics. She herself, who had
a passion for statistics, had been exasperated time and
again with the discrepancies in official statistical returns.
With great skill she pointed the way to a better system.
She was greatly helped and encouraged in her reform of
army statistics by Dr. John Sutherland, one of the lead-
ing sanitarians of his day; by Dr. William Farr, as
deeply interested in statistics as she; and by Dr. T.
Graham Balfour, who was appointed head of the sta-
tistical branch of the Army Medical Department. When
the recommendations of the commission on army reform
were carried out, the British Army statistics became the
best and the most useful then available in Europe.
Sanitary Reform in India
Florence Nightingale was not content with reforms
directed toward the health of the army at home. She
reached out to the troops in India, and her main work for
many years has been described as ''Health Missionary for
India.'' After an investigation into the existing sanitary
conditions of the Indian army, a commission, appointed at
her suggestion and working with her assistance, did for
the troops in India what sanitary reform had done for the
army at home.
Her interests in India spread from the troops to the
natives. She worked in season and out of season for
sanitary improvements in native living conditions and for
irrigation projects which would free the Indian farmers
from their ever-present fear of famine.
20
HEALTH HEROES— FLORENCE NIGHTINGALE
7s[ursing
School of
St. Thomas
Hospital
The Nurses Training School
While Florence Nightingale was still in the
Crimea, a movement was started to mark in some public
manner the nation's appreciation of her services. It was
decided to raise a fund for the establishment of a training
school for nurses of which Florence Nightingale would
be the head. This school, which was connected with St.
Thomas's Hospital in London, was opened on June 24,
i860, with fifteen probationers. On this modest scale
there was launched a scheme which was destined to found
the modern art and practice of trained nursing.
Florence Nightingale's own delicacy of observation
and fine nursing technique were indelibly impressed on
the first nurses' training school. In her book, ?{otes on
?v[ursing, are found the precepts which she insisted must
be translated into action. The welfare and comfort of the
patient must come first always. There must be plenty
of sunlight, proper ventilation and scrupulous cleanliness
in the sick room. The Nightingale Training School
created a new model for nurses and the Js[otes on 7<lursing
was its gospel.
21
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To Florence Nightingale, nursing was not a profes-
sion; it was a ''calling." It required a sound knowledge of
household hygiene, some knov/ledge of medicine and
surgery, and an acute and sympathetic faculty of observa-
tion. "Merely looking at the sick is not observing,''
Florence Nightingale used to say.
Although she herself could not take the superintend-
ence of her Training School, she kept in close touch with
It. She worked out all the practical details of its admin-
istration and saw to it that they were carried out. She was
anxious to have it become a home as well as a school, "a
place of training of character, habits, and intelligence, as well
as of acquiring knowledge.'' She guided the development
of the new nursing technique which she had originated.
She was always ready to give practical help and advice
to the Matron and the student nurses.
Her good wishes and her interest in their
welfare followed the Nightingale nurses
when they left the school to demon-
strate to the watching world her con-
ception of what a nurse should be.
It was not Florence Nightingale's
desire that the nurses trained in her
school should do private nursing. Her
nurses, when they had finished their
training, were expected to take positions
in hospitals, workhouses, poorhouses,
and other similar institutions. In this
way she thought that her training school
would be, in turn, the means of training
elsewhere. It was. The profession of
trained nursing, with its high standards
and with the expansion into the great
field of public health nursing, has grown
from that beginning. A modem nurse
11
HEALTH HEROES— FLORENCE NIGHTINGALE
Hospital Construction
The publication of Florence Nightingale's 7<lotes on
Hospitals in 1859 made her a recognised authority on
hospital construction. This book opened a new era in
hospital reform. After its publication she was deluged
with requests for advice in the building of new hospitals
or in the reconstruction of old ones. To her is largely-
due the credit for whatever is good in modern hospital
design and construction.
So widespread was the recognition of Florence
Nightingale's authority on questions relating to nursing
and hospital construction that she was officially consulted
by the Union Government during the Civil War in the
United States.
The Angel with a Flaming Sword
Florence Nightingale lived to be 90 years old. Just
three years before her death, she was given the Order of
Merit by King Edward VII. This is a very high honor.
It was the first time that it had ever been bestowed on a
woman. Congratulations came pouring in on Florence
Nightingale from all sides. The longer she lived, the
greater became her fame. In the popular imagination, to
the day of her death, she was the Lady of the Lamp,
the Angel of the Crimea, the tender woman whose
shadow the soldiers kissed as it fell on their pillows. But
to those with whom she worked during and after the
Crimean War, she was an angel with a flaming sword.
Her mind was the sword — hard, sharp, brilliant. Pas-
sionately she used it to do battle for those whom she saw
suffering needlessly. Ruthlessly she bared the easy-going
inefficiency which hitherto had made a disgrace of sanita-
tion and nursing, both in military and civil life. Without
sentiment, she pointed out the remedies and worked
ceaselessly for their adoption.
23
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Her spectacular experience in the Crimea was to
Florence Nightingale only one incident of the life work
she had chosen. Yet what thrills, what splendor, what
dreams of service it meant to the children and young
women of her day ! Through her heroism, nursing became
glorified. She lifted it from its lowly state to that of one
of the greatest professions which woman can follow. It
has been said that ''no woman who was not canoni2,ed, or
who had not worn (or been deprived of) a crown, has ever
excited among her sex so much passionate and affectionate
admiration, and set so many an example as Florence
Nightingale.''
REFERENCES
The Life of Florence 7V(ightingale, 2 Volumes, by Sir Edward T. Cook,
Macmillan and Company, London, 191 3.
"Florence Nightingale," in Eminent Victorians, by Lytton Strachey,
G. P. Putnam's Sons, New York, 191 8.
J^otes on Hospitals, by Florence Nightingale. Printed in Transac'
tions of National Association for the Promotion of Social
Science, 1858.
Nfites on J<[ursing, by Florence Nightingale. D. Appleton and
Company, New York and London, 1924.
Florence Nightingale as Statistician, by Edwin W. Kopf. Reprinted
from the Quarterly Publications of the American Statistical
Association, December, 1916.
24
p F M. — PRINTED IN U.S.A. — (e) 466 L.W. (Edition Jan. 1948 >