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The Collected Works of Florence Nightingale

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NIGHTINGALE'S SPIRITUALITY

Florence Nightingale: Faith and Work

Keynote Address by Lynn McDonald, PhD

Department of Sociology and Anthropology University of Guelph
for the 7th Annual Conference Canadian Association for Parish Nursing Ministry
Toronto May 27 2005

Florence Nightingale (1820-1910) was born in Florence, Italy (hence the name) of British parents. She was raised in England but returned to Italy for significant trips in her late teens (1838) and as a young woman (1847-48) for a winter in Rome.

She was baptized in the Church of England in Florence and, with her family, attended Church of England services when at home in Hampshire. Her father was patron of the living, in effect the employer of the local vicar. Two grandfathers and one grandmother were Unitarians, but the Nightingale’s parents were married in the Church of England and both they and Nightingale remained in it, although Nightingale strongly disagreed with its social, and sometimes its theological, conservatism. Nightingale’s paternal grandmother (the only grandparent she knew well) was fiercely low-church evangelical. When living at the family house, Lea Hurst, in Derbyshire, the family attended dissenting chapels, mainly Methodist.

Certainly a Methodist strain can be seen in Nightingale’s faith—she was very fond of John Wesley, as can be seen by references to him in a sermon and in correspondence. Lutheran influences, too, can be seen from her stay at the Deaconess Institution at Kaiserswerth-am-Rhein, near Düsseldorf, 1850 and 1851.1

Nightingale’s faith was shaped importantly by reading the books of an American Congregational minister and educator, Jacob Abbott, notably his The Corner-stone, or, a Familiar Illustration of the Principles of Christian Truth, 1834, which she later described to a friend as ‘the book that converted me,’ in 1836. The letter, published in Lynn McDonald, ed., Collected Works of Florence Nightingale, Women (8:), has not been noticed by other writers on Nightingale, who tend to see her either as purely, if unhappily Church of England, or who even describe her as Unitarian (which she was not, three grandparents notwithstanding). This experience of personal commitment was followed by Nightingale’s much better known call to service, 1837, which she talked about openly.

Nightingale’s faith was from childhood on nourished by wide reading, with regular reading of and study of the Bible (she knew the German historical and critical literature), the medieval mystics, the Puritans (especially John Milton, a family favourite, and Richard Baxter); the liberal French Dominicans, numerous popular religious novels, biographies of missionaries and saints, tracts from the Society for Promoting Christian Knowledge.

Faith and Work: the Links

Nightingale believed that God made the world and runs it by laws:

God governs by His laws, but so do we, when we have discovered them. If it were otherwise we could not learn from the past for the future. ('Essay in Memoriam,' in Society and Politics 5:60)

We should do careful, quantitative research, using the best methods possible, thereby to know and be able to apply God’s laws. When we do we become God’s 'co-workers,' or, for Nightingale liked to quote the Greek, συvεργoί which she did in her bible as 2 Corinthians, fellow workers.

Nightingale’s method as to how to gain this crucial information is still good advice:

Nonetheless, there is always the potential for unintended consequences, even with the best of intentions. Nightingale gave examples of acts done with the best of benevolent intentions, such as the establishment of a foundling hospitals for unwanted babies, but which had terrible outcomes, high mortality rates. This is a lesson she learned from the Belgian statistician L.A.J. Quetelet. It is fully explained in Society and Politics (vol. 5).

Nightingale advised that new social programs should be small and carefully monitored. Her own work always started small. Get some experience first: see how the institution, program, ward, training school, whatever, works before you are committed to large buildings, fixed programs, etc. Clearly this is still very good advice.

Biblical Foundations

From Nightingale’s lifelong reading of scripture we can see a number of places that gave her significant guidance. Two examples will be given here of key themes in her faith and work.

In Exodus 33:18, when Moses asked God, Show me thy glory, God answered: I will make all my goodness pass before thee.

For Nightingale, Athe glory of God is His goodness. [God] does not want to be praised, to be adored, to have His glory sung. We can scarcely conceive a good man…wishing it. How inappropriate, then, to Him all this praise! (from Suggestions for Thought 2:22) For Nightingale, this “praise” was so much burnt offering, that God despised. She believed that God wants us to act, to reflect God’s glory to the world by making it better, with practical achievements. Healing the sick was doing this, showing God’s goodness by doing His work in the world.

A letter to her father sets out her understanding of an activist faith very nicely. W.E. Nightingale, formally an Anglican but raised Unitarian, remained quite sceptical about matters of faith, and often provoked his daughter by what she considered a cynical stance. She thought faith was simple and straightforward, and, while she enjoyed reading scholarly discussions and arguments in theology, she also saw the dangers. How nicely she puts it in this (quite exasperated) letter, published in Theology (3:390):

It strikes me that all truth lies between these two: man saying to God, as Samuel did, Lord, here am I, and God saying to man as Christ did, in the storm, Lo it is I, be not afraid. And neither is complete, without the other. God says to man in suffering in misery, in degradation, in anxiety, in imbecility, in loss of the bitterest kind, in sin, most of all in sin, Lo, it is I, be not afraid. This is the eternal passion of God. And man must say to him, Lord here am I to work at all these things.

Nightingale in fact had kept saying, Here am I, send me, to God for years after her “call to service.” Her family did not permit her to nurse (it was an ill-paid job, not done by ladies, with rather more the status of kitchen maid).

Throughout her life Nightingale liked people who did things, who saw a need, heard a call, and went out and acted. She greatly appreciated missionaries—David Livingstone was a hero. Her fondness for Wesley similarly was for his willingness to go and do.

Mary’s acceptance of her mission, at the annunciation, was another favourite Nightingale passage, much quoted, paraphrased and widely applied. She saw herself as handmaid of the Lord, and referred to other women who had taken on nursing as a calling in the same terms.

Nightingale said 'Behold the handmaid of the Lord and so have I said in my youth.' (Luke 1:38). To a night nurse in 1886 Nightingale prayed:

May we all answer the angel as Mary did: Behold the handmaid of the Lord: be it unto me according to Thy word.

Prayer

Nightingale’s life of work was nourished by prayer as well as wide reading, and much devotional reading.2 She knew the Book of Common Prayer well, for excerpts appear frequently in correspondence. She believed that a life of prayer was needed to support active work, but that people should not live permanently in a cloister. Her comments on the medieval mystics show both this appreciation, and criticism. Her reflections show her following the liturgical year. Letters are often dated with Whitsunday, or the Conversion of St Paul, or St Andrew’s Day.

Nightingale believed that humans were not the only members of God’s creation who prayed and otherwise responded to God. She has been described, by a Roman Catholic bishop, as having a Franciscan spirituality.3 Birds—for Nightingale was a keen bird lover—appear often in correspondence as praying with us.

There is nothing makes my heart thrill like the voice of birds, much more than the human voice. It is the angels calling us with their songs. (1:434)

At the end of the 1882 war in Egypt Nightingale commented to her brother-in-law: 'Every little bird seems to sing its praise for this great mercy.' (3:400)

To summarize:

Absent from this list is any mention of prayer for healing. Nightingale’s own church at that time did not hold prayers for healing, laying on of hands or anointing with oil. Nor did any Protestant denomination, to my knowledge. Certainly the Lutheran Kasiserswerth did not. The use of extreme unction by the Roman Catholic Church was clearly preparation for death, with no suggestion of healing for this life.

English hospitals in Nightingale’s day had chapels and chaplains, Church of England, Roman Catholic likewise, but Nightingale’s involvement was with the Protestant hospitals. Nurses and nursing students were expected to attend services. Prayers were read in the wards, variously by the chaplain or a nurse, but these were the regular morning and evening prayer services of the Church of England, sometimes adapted, but without any use of healing prayers as would be commonly used now by parish nurses.

Nightingale’s Vision of a Public Health Care System

Nightingale was a systems thinker, which follows logically from her belief in a God of law, who made everything. Her approach to health care was holistic. She consistently stressed health promotion and disease prevention. The foundations for good health were:

Yet, even with the best of conditions—a long time in coming—some people would become ill. Her strategy for dealing with illness was again holistic, conservative-careful. Because of the great dangers of hospitals (how relevant Nightingale still is!) her work stresses treatment at home. Note that Nightingale began working on improving hospital safety even before her training school for nurses began. Notes on Hospitals, initially two papers at a conference, came out in 1858, and was augment and republished in 1859 (and again in 1863). Notes on Nursing appeared first in 1860 and the school opened in 1861.

Home visiting by doctor and nurse were first on her list. For those who could not afford private care Nightingale worked for the establishment of “district nursing,” the provision of visiting nurses. (There was then, of course, no medicare system, so that the poor depended on charity or the very minimal assistance of the Poor Law).

Hospitals were a last resort, because of their dangers. General, or acute care hospitals were essential, especially for some surgical cases, but these had the worst mortality rates. A patient should not stay in one a day longer than necessary, said Nightingale, not an hour longer in the case of a child.

Convalescent hospitals should be associated with general hospitals so that patients could be moved at the earliest possibility. Convalescent hospitals desirably would be in the suburbs, or, better still, at the seaside.

Nightingale’s concern for prevention, and good housing as essential for good health can be seen in a letter to her brother-in-law in 1868. The statement shows exaggeration (Nightingale was much given to hyperbole) but makes the point:

I believe that more moral and physical good is done by improving the dwellings of mankind than in almost any other way. And if all the money that is spent on hospitals were spent on improving the habitations of those who go to hospitals, and (on prisons) of those who go to prison, we should want neither prisons nor hospitals. (5:181)

The Introduction of Nursing into Workhouse Infirmaries

Perhaps the most important work Nightingale did was to bring professional, trained, paid nurses into the workhouse infirmaries, the dreaded institutions of Victorian, Dickensian Britain. Because hospitals required fees (there were some charity wards) the poor generally had to go into a workhouse infirmary when ill: there were five people in these institutions for every one in a regular hospital—they were the “real hospitals” of the sick poor. Doctors visited patients there, but the only nurses were not trained people, but simply other workhouse women inmates who were not themselves ill. Bed sharing, inadequate cleansing facilities, etc., were typical.

Nightingale had visited several of these places as a young woman, when she was not allowed to work. She was appalled—they broke the visitors heart as she later explained. She stopped visiting but kept thinking about what to do to reform them. We know that she discussed the issue while superintendent at the Establishment for Gentlewomen during Illness, pre-Crimea, during the Crimean War, when she was obviously enormously busy, and at Balmoral Castle visiting Queen Victoria post-Crimea.

The opportunity to act, however, did not emerge until William Rathbone, a Liverpool businessman and philanthropist, contacted her in 1864 with an offer to provide funding for a “lady visitor” to go into the Liverpool Workhouse Infirmary. Nightingale jumped at the opportunity. Obviously she had a scheme in mind, for she was ready with details. This is recounted in detail in volume 6, Public Health Care. Rathbone gave up his idea of a mere “lady visitor” for Nightingale’s insistence that what was needed was professional nursing.

The work is fine example of Nightingale’s faith in action. Here were the poorest and most desperate of God’s people, those greatest in need. No one else was working on this reform, although there were philanthropists trying to get rid of the worst abuses of the workhouse system (a good idea, too, but Nightingale’s vision was much bolder). Her understanding, like Tommy Douglas for Canadian medicare, goes back to the parable of the good Samaritan, being neighbour to those in need, regardless of differences of class or ethnicity.

As Nightingale explained to C.P. Villiers, president of the Poor Law Board in 1864 and thus the Cabinet member responsible for workhouses: when the “poor pauper” becomes sick he (or she) ceases to be a pauper and becomes a brother to the best of us and as a brother he should be cared for. This care, she stressed, meant “efficient nursing” (6:329). Moreover, because Nightingale was statistically competent, a “passionate statistician,” she understood that the need for hospitals and nurses could be predicted. Sickness was not an unpredictable event but the numbers of people needing what kind of care could be estimated.

The achievement of even the first steps towards quality hospital care is a long story. Nightingale worked to get legislation adopted in the British Parliament to get workhouse nursing started in metropolitan London. Unfortunately there were political difficulties—the Liberal Party, which had indicated support—was defeated and the Conservatives who followed them brought in a very inadequate bill. It was permissive only, and did not require any particular workhouse to institute any particular program. Reformers had to convince individual institutions to act. But at least the foundation was laid and reforms began.

Nightingale’s vision indeed went much further than the provision of quality hospital care for the poor. Her ABC of Poor Law reform was a rough sketch of an entire social welfare approach to the exigencies of old age, disability mental or physical and long-term illness. There is material on this in Society and Politics and Public Health Care. Throughout we can see her acting on her faith, of seconding God’s care for his poorest creatures, recognizing them as equals in the eyes of God, our own brothers and sisters.

The Collected Works of Florence Nightingale attempts to show much was accomplished by this woman following her call to service. But medicine and nursing have changed enormously since Nightingale’s time so that her work cannot serve as a model in specifics. Changes in the education and status of women also have enormously widened the opportunities women have to act on their calls to service. Nightingale can only be a rough model, then, for nurses. Yet I suggest that her careful methodical approach to public health work remains a useful model, for nurses, doctors, public health experts and various sorts of social scientists. The vitality of her faith is no less a model for those of us who share it.

The world has changed a great deal since Nightingale said to God, “Here am I, send me,” and God did!

Notes

1 For background material on Nightingale see the introduction to her life in volume 1, Life and Family, of the Collected Works of Florence Nightingale. See volume 2, Spiritual Journey, for an account of that journey, especially her biblical annotations, sermons and journal notes. See Theology, volume 3, for her theological essays and much correspondence, and volume 4, Mysticism and Eastern Religions, for her translations of and commentary on early mystics, her annotations of the Imitation of Christ, and Letters from Egypt; for the Kaiserswerth experience see volume 7, European Travels. All references to the Collected Works of Florence Nightingale here give the volume and page numbers. The 16 volume series is published by Wilfrid Laurier University Press, 2001-. See the website: www.wlupress.wlu.ca

2 There is further material on Nightingale’s spirituality on the project website, including material that can be used in liturgies commemorating Nightingale.

3 Leo Gregory Fink, “Catholic Influences in the Life of Florence Nightingale. St Louis MO: Catholic Hospital Association Bulletin No. 19.