Florence Nightingale at Scutari: The Lady with the Lamp

Florence Nightingale arrived at the British army’s Barrack Hospital at Scutari, across the Bosporus from Constantinople, on 4 November 1854, during the Crimean War. Over the next two years she organised nursing and supplies in hospitals overwhelmed by sick and wounded soldiers and became famous as “the Lady with the Lamp”. Her later use of statistics to show that most deaths were preventable transformed army medicine, hospital design and the profession of nursing.

Background: a hospital in crisis

When Britain went to war with Russia in 1854, its army medical services were small and poorly organised. The main base hospital was set up in the huge Selimiye Barracks at Scutari (today Üsküdar in Istanbul), lent by the Ottoman government. It sat on top of defective drains and had little furniture, bedding or equipment.

After the Battle of the Alma in September 1854, wounded men were shipped across the Black Sea in crowded transports, and many died on the voyage. The Times correspondent William Howard Russell and others reported that the British sick lacked basic care, while the French had nursing Sisters of Charity. Public anger in Britain was intense. Russia, too, was organising nursing: in Sevastopol the surgeon Nikolai Pirogov, who used triage to sort the wounded by urgency, worked with the Sisters of Mercy of the Exaltation of the Cross, a community founded by Grand Duchess Elena Pavlovna.

Who was Florence Nightingale?

Nightingale was born on 12 May 1820 in Florence, Italy, after which she was named, into a wealthy and well-connected English family. Against her family’s wishes she felt called to nursing, then seen as unsuitable work for a lady. She studied hospitals across Europe and trained in 1851 at the Lutheran deaconess institution at Kaiserswerth in Germany.

In 1853 she became superintendent of the Institution for the Care of Sick Gentlewomen in Harley Street, London. In October 1854 her friend Sidney Herbert, the Secretary at War, asked her to lead a party of female nurses to the military hospitals in Turkey. It was the first time women had been officially sent to nurse in the British army.

Arrival at Scutari

Nightingale left London on 21 October 1854 with 38 nurses, including Anglican sisters, Roman Catholic nuns and paid hospital nurses. They reached Scutari on 4 November, the day before the Battle of Inkerman sent a new flood of wounded towards the hospitals.

Army doctors at first resented the women and would not let them work in the wards. Nightingale insisted her nurses wait until asked. Within days the hospitals were so overwhelmed that the doctors accepted their help.

She soon became the hospital’s unofficial quartermaster. Using money from a fund raised by The Times and from her own resources, she bought shirts, bedding, food and medical supplies, organised a laundry and set up extra diet kitchens. She also wrote long, detailed letters to Herbert describing every failure of the system.

Discipline among her nurses was strict. They wore plain uniforms, were forbidden to go out alone and were sent home for drunkenness or misconduct. Nightingale wanted to prove that respectable women could work in a military hospital without scandal, and she was well aware that critics in Britain were waiting for her experiment to fail.

Her authority was often challenged. In December 1854 a second party of 46 women led by Mary Stanley arrived without her having asked for them, causing friction over who controlled the nurses. Religious tensions between Protestant and Catholic sisters, and long disputes with the army’s chief medical officer in the East, Dr John Hall, followed her throughout the war.

The terrible winter of 1854-1855

The winter brought disaster. Soldiers arrived from the siege lines before Sevastopol suffering from frostbite, scurvy, dysentery, cholera and typhus. At its peak in early 1855 the Barrack Hospital and its neighbouring General Hospital held thousands of patients.

Death rates rose rather than fell. In February 1855 the recorded mortality among patients at Scutari reached around 40 per cent. Overcrowding, contaminated water and blocked sewers beneath the building spread infection faster than nursing could counter it.

At night, Nightingale walked the long corridors with a lamp to check on the patients. A report in The Times described her as a “ministering angel” making her solitary rounds, and the image of the Lady with the Lamp was born. Soldiers’ letters home reinforced her reputation.

Her practical work was less romantic but just as important. She insisted on regular washing of patients and linen, separated the dying from the recovering where she could, and found ways for soldiers to send their pay home. She also set up reading rooms and classes for convalescent men, arguing that soldiers would behave well if treated with respect.

The Sanitary Commission and the turning point

In March 1855 the new government of Lord Palmerston sent a Sanitary Commission led by Dr John Sutherland and the engineer Robert Rawlinson. They found dead animals in the water supply and sewers that leaked under the wards. Their workers flushed the drains, cleaned and limewashed the walls and improved ventilation.

Mortality then fell dramatically, to a few per cent by the summer of 1855. The celebrated chef Alexis Soyer also arrived to reform the army’s kitchens and diet.

In May 1855 Nightingale travelled to the hospitals in Crimea itself, where she fell seriously ill with “Crimean fever”, probably brucellosis. She recovered but suffered from chronic illness for much of the rest of her life. In 1856 she was formally confirmed as general superintendent of the female nursing establishment of the army’s hospitals. She left Scutari in July 1856, months after the war ended, and returned to England quietly, avoiding public celebrations.

Statistics, reform and legacy

After the war Nightingale studied the hospital records with the statistician William Farr. She came to believe that the high death rate at Scutari had been caused above all by poor sanitation, and that thousands of deaths had been preventable.

To present her findings to ministers she used graphics, including her famous polar area or “rose” diagrams. These showed month by month how deaths from disease dwarfed deaths from wounds. Her report Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army (1858) fed into a Royal Commission and lasting reforms. Her influence reached hospital buildings too. In Notes on Hospitals (1859) she promoted the “pavilion” plan, with long, airy wards separated by open space, which shaped hospital architecture for decades. She also led an inquiry into the health of the British army in India, publishing evidence in the early 1860s that helped bring about sanitary reforms there.

In 1858 she became the first woman elected a Fellow of the Statistical Society of London, later the Royal Statistical Society.

A public Nightingale Fund raised around £44,000 in her honour. In 1860 it established the Nightingale Training School for nurses at St Thomas’ Hospital in London, which became a model for nursing schools worldwide. Her book Notes on Nursing (1859) was widely read.

Nightingale worked from her home for decades, advising on hospital design, army sanitation in India and workhouse nursing. In 1907 she became the first woman awarded the Order of Merit. She died in London on 13 August 1910, aged 90, and at her own wish was buried quietly in the family grave at East Wellow in Hampshire rather than in Westminster Abbey. International Nurses Day is celebrated on her birthday, 12 May.

Myths and facts

Myth: her nursing alone saved Scutari’s patients. Death rates rose in her first months there. The sharp fall came after the Sanitary Commission’s engineering work, as Nightingale herself later concluded.

Myth: she was the only nurse of the war. Many other women nursed soldiers, including the Jamaican-born Mary Seacole, French Catholic sisters and Russian nurses at Sevastopol.

Myth: she was a gentle, passive figure. In reality she was a forceful administrator and political lobbyist who clashed with officials and used her fame, letters and statistics to drive reform.

By the numbers

Timeline

• 1854, 21 October: Nightingale leaves London with 38 nurses.
• 1854, 4 November: The party arrives at the Barrack Hospital, Scutari.
• 1855, February: Mortality at Scutari reaches its peak.
• 1855, March: The Sanitary Commission arrives and begins cleaning the hospitals.
• 1855, May: Nightingale visits Crimea and falls seriously ill.
• 1856, July: She leaves Scutari after the end of the war.
• 1858: Her report on army health is printed and she is elected to the Statistical Society.
• 1860: The Nightingale Training School opens at St Thomas’ Hospital.

Why it matters

Nightingale’s time at Scutari turned nursing from a low-status job into a respected profession for women. Her statistical work showed that disease, not battle, was the main killer of soldiers, and it made sanitation a central part of public health and hospital design.