Florence Nightingale was born in Florence, Italy (hence her name), but raised by her wealthy family in England, educated primarily by her father. As a member of the upper class, she was expected to marry, to visit, and to entertain. She detested the prospect of this enforced, purposeless idleness, and throughout her 20s, she suffered frustration and depression. At age 16, she experienced a “call to service,” but her family refused to allow her to become a nurse, an unthinkable life for a lady, involving as it would exposure to disease, dirt, and violations of Victorian modesty concerning the human body; nurses were notorious for drinking on the job, demanding bribes, and being sexually available, if not actually prostitutes. It was not until she was 33 that she was finally able to practice nursing, as superintendent of an institution for gentlewomen.
In November 1854, during the Crimean War 4, Nightingale led 38 British women, the first to nurse in war, to Scutari (now known as Üsküdar, Turkey). The Barrack Hospital to which they were sent was merely a converted Turkish barrack, lacking in running water, functioning toilets, beds, bedding and laundry facilities. She worked assiduously to improve conditions. Its high death rates were brought down, but not until the arrival of the Sanitary Commission, which made the necessary structural repairs. Nightingale learned the lessons of infectious disease in the process. She returned to England a heroine, although seriously ill. She used a fund of about £50,000 fund raised in her honor at the end of the war to found the first secular training school for nurses. After the war, her chief collaborator was the head of the Sanitary Commission, with whom she had worked to bring down death rates at the Barrack Hospital. For most of her long life, she did research and wrote from her London home, meeting with officials and experts there. An expert methodologist, she was the first woman fellow of the Royal Statistical Society. She did substantial research for two royal commissions, on the Crimean War and on India, both situations with high rates of preventable mortality. She gave some 40 years of work to improving health care and preventing famine in India. At home, she did much to bring professional nursing into the dreaded workhouses. She was the first woman to receive the Order of Merit (1907).
For Nightingale, nursing was part of a broader approach to public health care, emphasizing prevention, health promotion, and hospital reform. Her work was grounded in a strong Christian faith, rather heterodox and liberal, drawing on sources well beyond her own Church of England. Reforms could be achieved by learning God’s laws, she believed, which required rigorous research and careful ongoing monitoring; in this way, people could become God’s “coworkers” in the betterment of the world.
Nightingale’s concern with suicide was both personal and professional. The early selections here, including a diary note dated Christmas Eve, 1850, exhibit her anguish over the choices she faced: whether to marry a man she loved, her long-time suitor Richard Monckton Milnes (knowing that marriage at that time would mean a life of domestic seclusion), or to reject the proposal in favor of a meaningful career (a barely tenable choice for someone of her societal position). Nightingale desperately wanted to work; to marry and thus foreclose this possibility, she said, “would seem like suicide.”
Nightingale made use of the Belgian statistician Adolphe Quetelet’s (1796–1874) work on suicide in Sur l’Homme et le developpement de ses facultés, ou Essai de Physique Sociale (1835) (Treatise on Man and the Development of his Faculties), which, much like the work of Durkheim [q.v.] over half a century later, used statistical methods in regarding suicide as something to be studied like other demographic phenomena. As Nightingale notes in Suggestions for Thought, this is not to assume that suicide is predetermined or “caused” by statistical laws.
While Nightingale generally regarded suicide as wrong, she regarded as an even greater wrong the administrative slackness and incompetence of many institutions, including hospitals and war agencies, which cost so many lives. Nightingale’s overall response to suicide or suicide attempts was to encourage compassionate rather than punitive treatment as a felony offense, in both her notes on George MacDonald’s serial novel Robert Falconer (3 vols., 1868) and in her insistence on the importance of care to prevent suicide and reform in hospital conditions, especially the understaffing of nurses. She also recommended that a column for “suicide” be added in the Army medical returns.
SOURCES
Selections from The Collected Works of Florence Nightingale, Waterloo, Ontario: Wilfrid Laurier University Press. Diary entries, 1850, from Vol. 2, Florence Nightingale’s Spiritual Journey: Biblical Annotations, Sermons and Journal Notes, ed. Lynn McDonald, 2001, pp. 383-384; passage from a draft novel and a fictional dialogue for Suggestions for Thought from vol. 8, “Notes on Nursing for the Labouring Classes (1861),” in Florence Nightingale on Public Health Care 6:67. Note to Benjamin Jowett, add. ms. 45783 f86; “Reflections on George MacDonald’s novel Robert Falconer,” from vol. 3, Florence Nightingale’s Theology: Essays, Letters and Journal Notes, ed. Lynn McDonald, 2002, pp. 631-632; “Truth and Feeling,” Theology 3:169; “Notes on Egypt,” Florence Nightingale on Mysticism and Eastern Religions 4:285, n. 298. Material in introduction contributed by Lynn McDonald.
from NOTE, CHRISTMAS EVE, 1850
In my thirty-first year, I can see nothing desirable but death. Entire change of air. Lord, Thou knowest my heart; I cannot understand it. I am ashamed to understand it. I know that if I were to see him [her suitor Richard Monckton Milnes] again, the very thought of doing so quite overcomes me. I know that, since I refused him, not one day has passed without my thinking of him, that life is desolate to me to the last degree without his sympathy. Yet, do I wish to marry him? I know that I could not bear his life, that to be nailed to a continuation and exaggeration of my present life without hope of another would be intolerable to me, that voluntarily to put it out of my power, ever to be able to seize the chance of forming for myself a true and rich life would seem to me like suicide. And yet my present life is suicide….
from NIGHTINGALE’S DRAFT NOVEL
Many are only deterred from suicide because it is more than anything else to say to God I will not–I will not do as Thou wouldst have me, and because it is no use.
from DRAFT FOR SUGGESTIONS FOR THOUGHT TO SEARCHERS AFTER RELIGIOUS TRUTH AMONG THE ARTIZANS OF ENGLAND (1860)
But between God and man there is no such agreement. Man did not ask to be born. God never asked man whether he would undertake the charge of himself or not. Many a one, if so asked, would certainly say, No, I cannot undertake this anxious existence, not even in view of the ultimate happiness secured to me. But He is too good a Father to put it into His children’s power to refuse it. If He were to do this, timid spirits would all resign at once. According to the theory of responsibility, suicide would be justified. For a man may put an end to his service, if dissatisfied with it….
…So Quetelet makes his computations that so many people will commit suicide, that so many widowers will marry three times; and we call it, and justly (supposing the computation correct), a law, and then, with our vague ideas that a law is a coercive force, we cry, “Oh! how horrid–then there is a law which compels so many people to commit suicide in a twelvemonth.” But the law, which is merely a statistical table, has no power to make people commit suicide. So you might as well say that Newton’s law has the power to make the stone fall as Quetelet’s table to make the people commit suicide. Newton’s law is nothing but the statistics of gravitation, it has no power whatever.
from NOTES ON NURSING FOR THE LABOURING CLASSES (1861)
The simple precaution of removing cords by which a patient can hang himself, razors by which he can cut his throat, out of his way, when inclined to do such things, is much neglected especially in private nursing. Many inquests upon suicides show this, and the friends are invariably absolved by the verdict!!
If you look into the reports of trials or accidents, and especially of suicides, or into the medical history of fatal cases, it is almost incredible how often the whole thing turns upon something which has happened because “he,” or still oftener “she,” “was not there.” But it is still more incredible how often, how almost always, this is accepted as a sufficient reason, a justification; why, the very fact of the thing having happened is the proof of its not being a justification.
from NOTE TO BENJAMIN JOWETT (c. 1866)
Now certainly the poor man who embezzles his employers’ money, knowing it to be wrong, and goes and commits suicide, is much better, in a much more hopeful state than these most respectable people, who are wilfully stupid, who cannot be saved, who commit the sin against the Holy Ghost every day, who commit and permit all kinds of atrocities (and report and write and write and report) not knowing them to be so….
…But I don’t see that people have in the least gone on to discover and apply the laws by which there shall be no more, e.g., suicides, idiots, lunatics, tho’ we have discovered (but not applied) the laws by which there shall be no more cholera. (We do not say now, what a mystery it is that God should permit that dreadful plague, cholera.)
from REFLECTIONS ON GEORGE MacDONALD’S NOVEL, Robert Falconer (1868)
Those who talk sententiously (to the suicide) of the wrong done to a society which has done next to nothing for him…. I should say to him: “God liveth: thou art not thine own but his. Bear thy hunger, thy horror in His name. I in His name will help thee out of them, as I may. To go before He calleth thee is to say ‘Thou forgettest’ unto Him who numbereth the hairs of thy head, such a loving and tender one who, for the sake of a good with which thou wilt be all content, and without which thou never couldst be content, permits thee there to stand–for a time–long to His sympathizing as well as to thy suffering heart.”…
from TRUTH AND FEELING
(unpublished essay, 1871 or later)Free will and necessity, regarded as they usually are, namely, as mutually exclusive theories, are doubtless little or no better than mere words. Is there not a higher point of view from which they may be seen to be partial or relative truths, false when separated, true when combined, like the two pictures in a stereoscope? Look at ourselves from our own side alone, as beings having no reference to God (and this is I am afraid what the respondent’s “matter of experience” comes to) we are free at all events to will. Look at ourselves from the side of an omniscient, omnipotent Being, as an opposite class of people do, (this really means think of God as omniscient, omnipotent and omni-one or two other things only, but devoid of all sense of that relationship between Himself and us, which when viewed from our side we call duty) and we can see no more room for man’s will now than for God’s will before. Rise above all this alternation and strife. It is a fancied freedom which the will exercises in opposition to God’s laws, for God’s laws are our laws, they are the laws of our own nature, essence and condition. It is a fancied necessity which constrains men to act, except in self-deterioration and destruction, according to God’s will. We are all free (as it is called) to commit suicide or murder, but our free will wills that we should not commit it.
from NOTES ON EGYPT: MYSTICISM AND EASTERN RELIGIONS
That Ergamenes, a king of Ethiopia, was a funny fellow. He was the first to abolish suicide: according to Wilkinson [Manners and Customs 1:307], it had hitherto been the custom for the Ethiopian kings to receive word from the priests when the gods desired their presence, to which summons the kings immediately attended. But Wilkinson confines this custom to the Ethiopians, whereas the great Ramesses himself committed suicide, not, as it seems, from any disgust of life as “in the high Roman fashion” nor from vanity which the oftenest prompts it now, nor was it considered any extraordinary event, but simply from impatience to enjoy the society of the gods and the rewards held out to men who love them. I confess, to me it seems more extraordinary it does not happen oftener than that it happens so often. It seems so natural to me that, if we really believed what we say, that the child should hasten into the presence of the Father whom it really loves, and by whom it believes itself to be loved, in a childish impatience, not waiting for the bell to ring or for the Father to want it. It seems to me a later and more perfect development of the human understanding than we usually see, to perceive that the Father is everywhere, that we shall not be really nearer Him in another state than in this, that nearness is not in place but in the state of spirit and that the submissive mind, which seeks only to be one with the Father’s will and sees that will in its circumstances, is really nearest to the Father’s presence.