After Miss Nightingale’s return from the Crimea it was expected that she would become the active leader of the nursing movement which her brilliant example had initiated. “We intend to be merciless to Miss Nightingale in the future,” said Mr. Sidney Herbert, “and see that her abilities are not allowed to slumber. The diamond has shown itself and must not be allowed to return to the mine. Miss Nightingale must be chained to the oar for the rest of her life. It is hers to raise the system of nursing to a pitch of efficiency never before known.”

Gladly indeed would Miss Nightingale have started on the great work of nursing reform had her health permitted. The spirit was more than willing, it was eager to start, but the flesh was weak. It was hoped that a few months’ rest would restore her health, and that she would herself be able to organise an institute for the training of hospital nurses, to which purpose she proposed to devote the Nightingale Fund. Unfortunately, as time passed it became apparent that the malady from which she suffered was increasing, and that she would never again be able to lead her old active life.

It was indeed a hard cross to bear for a woman comparatively young and with a mind full of humanitarian projects, and as the first years of waiting passed Florence Nightingale drank deep of the cup of life’s disappointments. But she faced the situation with noble resignation. All through the land were brave fellows who had returned from the war maimed or shattered in health, and the soldier’s nurse showed the soldier’s heroism in the service of her country.

But though compelled to be a recluse, not a day of Miss Nightingale’s time was passed unoccupied. Work, work, ever work, was her great panacea. She spent a good deal of her time in London, for she liked to be in the “hum” of things and within easy communication of kindred spirits in the great city.

Her sick-room might have passed for an adjunct of the War Office, so filled was it with schemes for army hospital reform and communications from all sorts and conditions of soldiers. Whenever “Tommy” had a grievance, he wrote to Miss Nightingale. She was still his Lady-in-Chief, and invested in his mind with unlimited power and influence, and to some extent he was not mistaken. The War Office authorities had such a profound belief in Miss Nightingale’s judgment and discrimination that any recommendation made by her received attention. She was able to render help to deserving men with regard to their pensions, and in procuring civil occupation for the maimed and disabled, while she was an ever-helpful friend to the widows and orphans, and by her influence obtained grants from the Patriotic Fund for many destitute soldiers’ families. The amount of work of this kind which Miss Nightingale did in the year succeeding the war is incalculable.

When in 1854 her name had first come before the public, nothing was known of Miss Nightingale, but now that it was understood that she was the daughter of a rich and influential gentleman, she was overwhelmed with begging letters. These increased to such an extent that she was forced to make a public protest in The Times and state her inability to reply to the letters which poured in upon her. However, let it be stated to the honour of the army that not a single begging letter for money was ever sent to Miss Nightingale by a British soldier.

During the first years of her illness Miss Nightingale still hoped against hope that she might be sufficiently restored to health as to be able to take active steps for the formation of an institute for nurses, and in 1859 it was still thought by the Committee that she would eventually be able to administer the Nightingale Fund, and it agreed to hold the scheme in abeyance. At this time the sum subscribed and the accumulated interest amounted to £48,000. After another year had passed and her health showed no signs of improvement, Miss Nightingale entered into an arrangement by which she placed the money in the hands of trustees for the training of hospital nurses. The net income of the fund amounted to £1,426 and a Council was named to administer it. Miss Nightingale, to whom the fund had been a personal gift from the nation, only reserved to herself the power to give advice. The Hon. Sidney Herbert, shortly to become Lord Herbert of Lea, was the guiding spirit of the Council.

It was arranged with Miss Nightingale’s approval to devote two-thirds of the income to the maintenance and instruction of nurses at St. Thomas’s Hospital, the probationers engaging to take service in public hospitals and infirmaries. The remaining third was to be spent at King’s College Hospital for the maintenance and instruction of midwifery nurses, the want of whom was at that time much felt in the villages of England.

The movement thus begun by Florence Nightingale for the systematic training of lay hospital nurses was first established at old St. Thomas’s Hospital, near London Bridge, in 1860. This hospital was one of the oldest foundations in the country, having been first established in 1213 as an “almery” or hospital in connection with the Priory of Bermondsey. It was later assigned for the use of the poor. At the dissolution of the monasteries St. Thomas’s was surrendered to Henry VIII. It had then forty beds for poor people, a master, six brethren, and three lay sisters. Later it was enlarged and opened as a hospital for the sick poor under the patronage of the young King Edward VI. During the period of the Restoration it was used as a military hospital, and is mentioned in this connection by Pepys in his Diary. In 1732 it was rebuilt and the grand entrance made from Wellington Street, Southwark. It is interesting to find that at this period each ward of the hospital was under the care of a sister and two or three nurses.

In selecting St. Thomas’s for the home and training school of her pioneer nurses, Miss Nightingale was carrying on the traditions of the hospital, as nursing sisters had been associated with it from early times. It also specially commended itself to her sympathies as being one of the oldest institutions in the kingdom where the sick poor could be relieved. Later, the hospital was rebuilt in palatial style on its present site on the Thames Embankment, and the Nightingale Training Home became a part of the new hospital.

Meantime, an upper floor in a new wing of old St. Thomas’s was arranged as the quarters for the Nightingale nurses. There was a separate bedroom for each probationer, a common sitting-room, and two rooms for the sister-in-charge.

In May, 1860, candidates were advertised for, and on June 15th the first fifteen probationers were admitted. They were under the authority of the matron and subject to the rules of the hospital. They were provided with board and lodging, received a salary of £10 during the first year of their probation, and were to serve as assistant nurses in the wards and receive instruction from the sisters and medical officers. At the end of a year those who passed examination were certified as nurses and entered into hospital work. The first superintendent of the Nightingale Training School was Mrs. Wardroper.

During the first year of the experiment four probationers were dismissed and others received in their places. Out of those who were placed on the register as certified nurses, six received appointments in St. Thomas’s, and two entered workhouse infirmaries.

It was an anxious year for Miss Nightingale, and many heart-felt prayers went up from her sick-room that the work might be successful, while she encouraged the young probationers by friendly chats and advice. The Council considered the result of the first year satisfactory, and the scheme continued to steadily work.

It is clear, however, that the girls of England were not then all “mad to be nurses.” The profession had not become fashionable. Mrs. Grundy still shook her head over “young females” nursing in hospitals and feared wholesale elopements with medical students. Parents were afraid of infection; the fastidious thought attendance upon the sick poor incompatible with the feelings of a lady, and there was the conventional idea that it was derogatory to the position of a gentlewoman to enter a wage-earning profession.

Miss Nightingale fought steadily and patiently against criticism and prejudice, and now and again from her sick-room came stirring appeals to the young womanhood of England that they would regard the nursing of the sick as the noblest work to which they could devote themselves. “We hear so much of idle hands and unsatisfied hearts,” she wrote, “and nowhere more than in England. All England is ringing with the cry for ‘Woman’s Work’ and ‘Woman’s Mission.’ Why are there so few to do the work?... The remunerative employment is there, and in plenty. The want is the women fit to take it.”

Miss Nightingale then goes on to explain the kind of training given to her nurses at St. Thomas’s, and although this was written in the first stage of the work, when she was asking for recruits, it remains the basis upon which the Nightingale Training School in the present palatial St. Thomas’s Hospital is conducted.

“We require,” she writes, “that a woman be sober, honest, truthful, without which there is no foundation on which to build.

“We train her in habits of punctuality, quietness, trustworthiness, personal neatness. We teach her how to manage the concerns of a large ward or establishment. We train her in dressing wounds and other injuries, and in performing all those minor operations which nurses are called upon day and night to undertake.

“We teach her how to manage helpless patients in regard to moving, changing, feeding, temperature, and the prevention of bed sores.

“She has to make and apply bandages, line splints and the like. She must know how to make beds with as little disturbance as possible to their inmates. She is instructed how to wait at operations, and as to the kind of aid the surgeon requires at her hands. She is taught cooking for the sick; the principle on which sick wards ought to be cleansed, aired, and warmed; the management of convalescents, and how to observe sick and maimed patients, so as to give an intelligent and truthful account to the physician or surgeon in regard to the progress of cases in the intervals between visits—a much more difficult thing than is generally supposed.

“We do not seek to make ‘medical women,’ but simply nurses acquainted with the principle which they are required constantly to apply at the bedside.

“For the future superintendent is added a course of instruction in the administration of a hospital, including, of course, the linen arrangements and what else is necessary for a matron to be conversant with.

“There are those who think that all this is intuitive in women, that they are born so, or, at least, that it comes to them without training. To such we say, by all means send us as many such geniuses as you can, for we are sorely in want of them.”

While Miss Nightingale was thus piloting nursing reform in the country and endeavouring to enlist recruits, she was also actively engaged in assisting the Hon. Sidney Herbert in carrying out his important schemes for the improvement of the condition of the soldier, a work to which Mr. Herbert devoted himself most strenuously in the last years of his life.

Up to the period of the Crimean War the sanitary condition of the soldier was utterly neglected. He was as a general rule left to his chance. At home in barracks he was ill-lodged and ill-fed, and during active service was practically uncared for. He was a constant victim to preventable disease by reason of unhealthy camps and ill-managed and defective hospitals. Fever and dysentery slew their tens of thousands. The mortality returns showed a deplorable death rate. Seventeen out of every thousand soldiers died annually at home as against eight in every thousand of civilians. It was calculated at this period that of every two soldiers who died, one died from causes which a proper attention to his surroundings would have removed.

Miss Nightingale had probably the best first-hand knowledge of any person in the country of the ills to which the soldiers in camp and hospital were subjected during active warfare, and the wealth of her experience and knowledge were given to Mr. Sidney Herbert when he started on his campaign of reform.

We have already seen the marvellous change which Miss Nightingale had been instrumental in bringing about in the military hospitals in the East, and the useful work she had accomplished during the last months in the Crimea by providing useful occupation and recreation for the convalescent soldiers and the men in camp, and by furthering reforms in the cooking and diet of the soldiers. The war was ended, the army was home again, and it now remained to see that the men who took up arms for their country should have their lives protected by the ordinary rules of health and sanitation, and that they should be educated, encouraged to live like self-respecting citizens of the Empire for which they fought, and that their wives and children should be cared for. Our heroine was not actuated by mere passing emotions easily roused and as readily quieted. Florence Nightingale had sacrificed her own health to cure the ills arising from the soldiers’ neglected condition and now turned her attention to prevention.

The horrors of the Crimean War impelled Sidney Herbert to concentrate his attention on army reform, a matter upon which he had been engaged before the outbreak of hostilities. Now he returned to it with redoubled vigour. Barracks as well as hospitals must be reorganised, the soldier preserved in health as well as tended in sickness. There must be good sanitary regulations, improved military cookery, and the soldier must have some enjoyment in life.

Mr. Sydney Herbert had to endure his share of blame with the other members of Lord Aberdeen’s Government for the terrible sufferings of the troops during the Crimean War, but for which in the light of history no one seemed less to blame than he, if blame there was, and he atoned for it now by a long penance of work for the good of the soldier. For every man who had perished in those bitter trenches before Sebastopol, died in the ill-fed camps of hunger or disease, or groaned his life away in the crowded and pestilential hospitals, Sidney Herbert saved at least the life of one British soldier by his labours.

He was the mainspring of the Royal Commission which, after the return of the troops from the Crimea, was appointed to inquire into the sanitary condition of the army, and on his suggestion and with his assistance four supplementary Commissions were issued on the subjects of Hospitals and Barracks, Army Medical Department, Army Medical Statistics, and on a Medical School at Chatham, and he drafted the code of regulations for the Army Medical Department which appeared in October, 1859.

With the return of Lord Palmerston to power in the summer of that year, Sidney Herbert again took office as Secretary for War. He now laboured more assiduously than ever in army reform, and in the furthering of those schemes which he had been compelled to abandon on the outbreak of hostilities. To his efforts were due the constitution of the militia, the reconstruction of the artillery system, the amalgamation of the Indian and the general forces, and the consolidation of what were then the “new” volunteers. At Aldershot he established instruction in barrack and hospital cookery, and in place of that peculiar method which required that the soldier should fit his foot to the boot, had the machinery of the boot-factory constructed to secure a variety of sizes to suit different feet, thereby adding to the comfort and marching power of the troops.

Sidney Herbert began the overwhelming task of reorganising the War Office, but the strain of work unfortunately compelled him to retire from active official position, and in 1859 he accepted a peerage and entered the House of Lords as Baron Herbert of Lea.

Lord Herbert still continued his efforts on behalf of bettering the condition of the soldier morally and physically, but his beneficent career was soon to be cut short. To the deep regret of all classes in the country Lord Herbert of Lea died on August 2nd, 1861, at Wilton House, Salisbury. Just before his death he had reformed the Hospital Corps, and the very day on which he died saw the opening of the General Hospital at Woolwich, which had been planned under his auspices as a model of what a military hospital should be. It was ultimately transformed into the present magnificent building, on which Queen Victoria fittingly bestowed the name of the Herbert Hospital.

Next to his devoted widow and children there was no one who felt more keenly the loss of Lord Herbert of Lea than Florence Nightingale. To his inspiration and support she owed in great measure the success of her mission to the Eastern hospitals, and since her return she had laboured with him to promote the betterment of the soldier’s condition. How much the nation really owes to Miss Nightingale for her labours in the sanitary and educational reform of the army during the years 1857–60 in which, though a prisoner in her sick-room, she toiled with Lord Herbert, will not be known until the private records of that period are published. At the request of the War Office she drew up an exhaustive and confidential report on the working of the Army Medical Department in the Crimea, which materially assisted in the reorganisation of the medical branch of the service then taking place.

In writing on “The Sanitary Condition of the Army” in The Westminster Review for January, 1859, Lord Herbert frequently quotes the opinions of Miss Nightingale, based on her experiences of the defects of the military hospitals’ nursing system, and mentions her recommendations for reform.

Her services and advice were not only highly valued by Lord Herbert, but were acknowledged by the first statesmen of the day. In the tributes paid to the memory of Lord Herbert at the time of his death, the name of Florence Nightingale was coupled with his in the work of army reform.

At a meeting held in Willis’s Rooms on November 28th, 1861, to consider the erection of a memorial in London to Lord Herbert of Lea, Lord Palmerston, then Prime Minister, speaking of the work in army reform accomplished by Lord Herbert, with the assistance of the Duke of Cambridge, Commander-in-Chief, said: “There were not only two; there was a third engaged in these honourable exertions, and Miss Nightingale, though a volunteer in the service, acted with all the zeal of a volunteer and was greatly assistant.”

Mr. Gladstone, then Chancellor of the Exchequer, followed with a similar appreciation. Referring to the above remarks of Lord Palmerston, he said: “My noble friend who moved the first resolution directed attention to one name in particular that ought never to be mentioned with any elaborate attempt at eulogy; for the name of Miss Nightingale by its own unaided power becomes a talisman to all her fellow-countrymen.”

Mr. Gladstone then proceeded to summarise the work of Lord Herbert in which our heroine had so signally helped. “To him we owe the Commission for Inquiry into Barracks and Hospitals, to him we are indebted for the reorganisation of the Medical Department of the Army. To him we owe the Commission of Inquiry into and remodelling the medical education of the army. And lastly we owe him the Commission for presenting to the public the vital statistics of the army in such a form, from time to time, that the great and living facts of the subjects are brought to view.”

Such was the perfect knight, the gallant gentleman, and the high-souled reformer whose loss Florence Nightingale now deplored. From her sick-room she followed with interest the schemes to honour his memory. It was proposed to erect his statue outside the War Office in Pall Mall, and to endow an exhibition of gold medals in connection with the Army Medical School at Chatham, which had been founded under his auspices. At Salisbury, the city where the names of Lord and Lady Herbert were household words as benefactors to the sick and distressed, a public meeting was held to promote a fund for erecting a bronze statue to Lord Herbert and for the support of a Convalescent Hospital at Charmouth as a branch of the Salisbury Hospital, to which he had been such a liberal benefactor.

Miss Nightingale had also the satisfaction of knowing that the reforms at which she had laboured with him were already bearing fruit. This was being demonstrated in China at this time (1860–64) where General Gordon was waging war against the Taiping Rebellion. While, during the first seven months of the Crimean War, the mortality amongst the soldiers had been at the alarming rate of sixty-one in every hundred per annum, exclusive of those killed in action, in the Chinese campaign, when the army had been sent half across the globe to an unhealthy country, the death-rate, including the wounded, was little more than three men in every hundred per annum, while the loss of those killed in action amounted to less than six men in every hundred per annum.

But now her chief was gone, cut off in the prime of his manhood, and at the pinnacle of public estimation and usefulness, and Miss Nightingale’s usually hopeful spirit grew despondent. The following letter, written fourteen months after Lord Herbert’s death, reveals how sorely she was suffering in body and in spirit. She writes:—

Happily the succeeding years brought some improvement in health, and the gloomy forebodings of this letter were not realised. After her recovery from the shock occasioned by Lord Herbert’s death, Miss Nightingale continued to give her experience and advice in matters of army and hospital reform both at home and abroad. She had correspondents in all parts of the globe, and the builders of hospitals and pioneers in nursing and sanitary reforms all drew from the fount of her practical knowledge.

She took a deep and sympathetic interest in the Italian War for Liberty, for she had herself been born on Italian soil, and felt something of the patriot’s spirit as she followed the progress of the Italian arms both in the struggle for independence and in the Austro-Prussian War of 1866.

In response to a request in 1866 from Cavaliere Sebastiano Fenzi, one of the committee for organising a system of volunteer assistance to the hospital department of the Italian army, that she would come to Florence to give advice and personal superintendence, Miss Nightingale replied giving a lengthy series of recommendations. We quote the conclusion of the letter for its personal interest:—

Miss Nightingale would certainly have been cheered in her sick-room if she could have seen the enthusiasm and emotion excited in her native city when her letter was read to the people.

The United States, which has to-day such an efficient organisation for the succour of the sick and wounded soldiers, owes the inception of the movement to Florence Nightingale. When the American Civil War broke out in 1860, her name had become a talisman not only to her fellow-countrymen, but to English-speaking people all over the world, and to her example the women of the United States looked when their land became devastated by war. Soon after the outbreak of hostilities, women in the leading cities of the States formed themselves into working parties to provide lint and bandages and suitable clothing for the suffering soldiery. But as the colossal needs of the regiments being formed all over the States became apparent, a special Sanitary Commission was, at the instance of various Medical and Relief Associations, founded by the Secretary of War to deal with the sick and wounded in hospital and camp. Hundreds of women volunteered as nurses, and in time a most efficient organisation was built up.

The observations and advice of Miss Nightingale were continually laid before this Commission, and her name became almost as much a household word in the States as at home. She was regarded as the great friend of the American soldiers and the beneficent genius of their hospitals. Had Miss Nightingale been in a more robust state of health, there is little doubt that she would have visited America during this great crisis, to give personal help in the initial work of the establishment of army nursing.

About this period, also, the seed of her example bore fruit in the establishment of the Red Cross Society, the branches of which to-day cover the civilised world. The honour of the inception belongs to M. Henri Dunant, a citizen of Geneva, who, appalled by the fearful carnage and disease among the soldiery in the Italian campaign, succeeded in drawing together an International Congress at the city of Geneva on October 26th, 1863, to consider how a neutral body might be formed for the relief of the wounded in battle. The result of Henri Dunant’s grand scheme was the extension of the work begun by Florence Nightingale in the Crimea over the entire Continent of Europe by means of the Red Cross Societies, which act in close relationship with their respective Governments and in conjunction with the army.

The work thus begun spread rapidly when that most sanguinary struggle of modern times, the Franco-German War, broke out in 1870. During that period Miss Nightingale’s advice was repeatedly sought and she was specially appealed to by the German authorities when organising their medical and nursing corps.