In the spring of 1895, when Edith was twenty-nine, the Reverend Cavell became ill, probably with pneumonia. Mrs. Cavell begged Edith to come home and look after her father. Edith wasted no time in returning to the Swardeston vicarage, but she was sad to leave her job with the François family, and sad to move from Brussels, which she thought of as her second home. Her family, however, had first claim on her loyalties.

  Edith cared for her father through the summer, providing him with the nursing he so desperately needed. It might have been expected that Mrs. Cavell would have asked Florence or Lillian to look after their father, since they were trained nurses. But she turned to Edith, the daughter she most relied on. Edith performed so capably that the Reverend Cavell returned to his church full-time by early autumn.

  The experience with her father came as a final revelation for Edith. Over the years, since her visit to the Free Hospital in Bavaria, she had been thinking about nursing as a career. At last, feeling the satisfaction of bringing the Reverend Cavell back to health, she made up her mind once and for all: She would train to become a full-time nurse.

  Sixteen-year-old Florence Nightingale (seated) and her sister, Parthenope, lived the pampered life of the very rich in nineteenth-century England. (The Toronto Reference Library)

  Chapter Three

  THE WOMAN WHO INVENTED NURSING

  Far more than anyone else, Florence Nightingale shaped the profession that Edith was about to enter. Before Nightingale, nursing – as we know it in the modern world – didn't exist. In the mid-nineteenth century, nurses were of two kinds, both incapable of giving proper care. One kind was made up of members of Anglican and Catholic religious orders, and while good-hearted, the women were often more interested in saving the souls of their patients than in treating their illnesses. The second kind came from the lowest classes. They were women who carried out little more than housemaid's chores, who sometimes got drunk on the job. Neither sort of nurse had formal training in looking after sick people, nor were they expected to do much beyond keeping the patients as comfortable as possible while they waited to die. Then along came Florence Nightingale.

  Florence was as different from Edith as day is from night. She was born in 1820 to a life of privilege. Her immediate family – father, mother, and older sister, Parthenope – divided their time between two handsome country estates. When the family traveled to London for parties and balls, they stayed in lavish hotel suites. From her childhood to her death in 1910, Florence Nightingale moved in circles that included England's powerful elite.

  Florence's father was quick to recognize that his younger daughter had a brilliant mind. He made sure she received a broader education than most boys of the time. Florence, who was Anglican, believed that God appeared to her on February 7, 1837, when she was seventeen, and called her to His service. Florence decided that the service lay in nursing. Driven to care for the ill, she was forever rushing to the bedsides of sick friends and relatives, and she developed an instinct for treating people in medical need. With her intellectual nature, Florence researched every corner of the health profession. She visited hospitals in England and on the continent, learning the techniques of nursing and keeping notes on each hospital's methods.

  Florence's parents opposed their daughter's fascination with medicine every step of the way. To them and to everyone else of their class, nursing was no activity for a lady. They expected her to marry someone of her own social standing and raise a family. Like Edith Cavell, Florence Nightingale remained single; unlike Edith, Florence had the money to follow her passion for healing wherever she wanted it to take her.

  Florence's chance to put the ideas she formed about nursing into effect arrived when Britain entered the Crimean War in the spring of 1854. The war pitted Britain, France, and Turkey against Russia, all the countries quarreling over small differences. On the battlefields, the fighting took place in a part of the world that few English people could have found on a map. It was in the Crimea, a remote region of southwest Russia on the Black Sea. Britain sent fifty thousand poorly equipped troops to the distant battleground, led by incompetent generals. From the beginning, the soldiers suffered from disease, wounds, and medical neglect.

  In response, Florence Nightingale recruited thirty-eight nurses, and under her leadership, the nursing team sailed to the war zone to save lives. They landed in Turkey, in November 1854, to a cold reception from the British officers and the army doctors. Both groups looked on Florence as a pushy woman, sticking her nose into a place where she wasn't wanted.

  Florence ignored the opposition. She took over a hospital in an abandoned Turkish army barracks in Scutari, a suburb of Turkey's major city of Constantinople. The building had no running water, few beds, and was unready in every imaginable way to receive sick and wounded soldiers. Florence soon put things in order. She and her team scrubbed away the building's filth, she spent her own money on beds and equipment, and she inspired her nurses to work with discipline and efficiency.

  Over the next many months, thousands of soldiers who needed medical treatment were transported by ship across the Black Sea, from the Crimean battlefields to Scutari. At the hospital, Florence created an institution so different from other military hospitals that it amounted to a revolution in caregiving. She emphasized fresh air, pure water, and washed sheets on every bed. She preached good hygiene and plenty of nourishing food.

  Today, we take for granted that hospitals, even at scenes of war, meet a minimum standard of cleanliness. But in the 1850s, such a notion was unheard of. Medical science hadn't yet grasped the concept of germs, which spread disease. But Florence's ideas about hygienic conditions made an enormous difference in the speed of healing among the soldiers and on the rate of their deaths. Even the military doctors, who were so scornful of Florence, had to admit that far fewer men died at Scutari than expected, and those who survived improved more quickly than the doctors thought possible.

  Florence Nightingale ran a military hospital for almost two years in the Crimean War of the mid-1850s. Her rounds of the wards each night made her famous as the “Lady with the Lamp,” though the lamp she carried bore no resemblance to the one in this picture from The Illustrated London News of Feb. 24, 1855. Florence's real lamp was described as “a candle inside an accordion-style shade that could be folded flat,” which she held over her head. (The Library of Congress, Washington, D.C.)

  Florence, working eighteen hours a day, performed more nursing than any of her staff. She didn't turn away from the soldiers with the most festering wounds, or the worst cases of dysentery. At night, she wrote long reports to the government in London, explaining her methods and making her case for money and equipment. Before finally resting her head on the pillow each night, she took one last tour of the hospital wards. She walked the four kilometers of beds, lighting her way with a small Turkish lamp held over her head. The men idolized Florence as the “Lady with the Lamp.”

  At home in England, the Lady with the Lamp turned into a famous figure. The war made the front pages of every newspaper, and Florence Nightingale's nursing became an exciting part of the story. In the spring of 1856, a peace treaty brought an end to the war, which had produced few results apart from killing and maiming thousands of men on both sides.

  The following autumn, Florence traveled back to England. She had spent twenty-two months in Turkey, taken three trips from Scutari to the battlefields, and survived an illness that almost cost her life. In England, she was revered and celebrated, though Florence proved to be an elusive subject for her admirers; what she didn't want for herself was celebrity. But it was beyond doubt that Florence's achievements at Scutari had raised the status of nursing as a profession. It was now respectable, as it had never been before, for a decent Englishwoman to become a nurse. Nursing itself was now looked on as something that could save lives, not just comfort those who were dying.

  Florence Nightingale was an eccentric person. Just how odd she was became clear in the decades after her return from the war. In that long period, she lived much of her life as a recluse, in a house that her father bought for her in London's posh Mayfair district. From her late thirties to her death at age ninety, Florence rarely left her home. Instead, she devoted every waking hour to reading and writing about hospitals and the people who worked in them. Nobody knew more about the subject than she did. At the request of the British government, she wrote an eight-hundred-page report called “Notes Affecting the Health, Efficiency and Hospital Administration of the British Army.” The document was her first shot in the long and successful campaign to introduce her ideas about clean water, warm clothing, and trained nurses to both military and civilian hospitals.

  She wrote about the training of nurses in Notes on Nursing, a book that was accepted as the last word on the matter and that remained in print for decades. The book changed the nature of nursing forever. Nurses in England would no longer be excessively religious or hopelessly alcoholic. Instead, they would be women who received training in the lessons of effective patient care. They would be taught to understand the instructions of doctors and surgeons. They would be dedicated professionals.

  This was the kind of nurse who graduated from the school established at St. Thomas' Hospital in London in the late 1850s. The school, which was named the Nightingale Training Hospital for Nurses, adopted Florence's lessons, and the nurses who graduated from it, and from all the other hospital teaching institutions just like it, became the nursing profession's models. Through her ideas and influence, Florence Nightingale became the founder of modern nursing.

  Edith Cavell never met Florence Nightingale, and it's unlikely that they ever corresponded, though Nightingale was a prodigious letter-writer. When Edith set off on a career in nursing in 1896, Florence was seventy-six years old and past the period of her greatest activity. Still, Edith was as aware as any other young Englishwoman of Florence's influential work. She would soon study Notes on Nursing as part of her training. She would come to understand the Nightingale principles because they were the basis of the profession that Edith had come to choose for her own.

  OPPOSITE: After her return from the Crimean War, Florence wrote countless reports and books about health care and the training of nurses. Her influence changed the profession of nursing forever. (The Library of Congress, Washington, D.C.)

  From her childhood to her adult years, Edith loved to sketch and to paint in water-color She drew this unidentified London scene in 1902, when she was night superintendent at London's St. Pancras Infirmary. (The Royal London Hospital Archives)

  Chapter Four

  NURSE EDITH

  On September 3, 1896, at the age of thirty, Edith entered the London Hospital (known simply as the London) to begin four years of training. The London occupied many buildings on acres of land on Whitechapel Road, a wide and chaotic street that ran through the slums of the city's East End. Traditionally, the East End was the first home for poor immigrants to England, and in Edith's time, the area took in the country's largest population of Jewish refugees from eastern Europe. Edith could have done her training at a hospital in a more prosperous neighborhood. But she chose to work and live at the London, where she knew she would be nursing the poorest patients.

  The London opened its doors in 1740. One of its early surgeons, Sir William Blizard, gave the hospital its motto: THE PATIENT COMES FIRST. As the words suggest, the London grew famous for the unselfishness of its surgeons, including Sir William, who must have had astonishingly hardy health since he didn't retire until he passed his ninetieth birthday But Sir William's durability made him an exception among early surgeons; as a group, they tended to die young. In the days of primitive instruments and of diagnoses that were far from scientific, surgeons put in weary days of performing operations with a high rate of failure. Though surgical techniques greatly improved in the late nineteenth century, surgeons' lives were, more often than not, short and hard. The pattern seemed to have been set by John Harrison, the London's very first surgeon, who took up his practice at age twenty-two and died just thirteen years later. The official cause of death was overwork.

  The demands on the nurses at the London were just as unforgiving. When Edith started out as a probationary nurse, one of the staff of six hundred nurses, her day opened with the ringing of a bell at 6:00 in the morning, and it didn't end until 9:20 at night, when she went off duty and ate her supper. She was never idle during all those hours. She learned the skills of nursing by working alongside senior nurses, who were in charge of wards of patients, fifty-six beds to each ward. Edith attended lectures, absorbing the principles that had been developed by Florence Nightingale. As a probationer, she had the responsibility of cleaning and dusting the wards. Since each ward was heated by a large fireplace, clearing the soot was an endless task.

  In theory, Edith was allowed time for meals during the day, but in a busy hospital, the reality was that nurses were lucky if they could leave their patients long enough for tea and a bun. Porridge turned up at every meal: porridge at breakfast, porridge and mincemeat at dinner, porridge and cold beef on Sundays. The one treat at the evening meal was a choice of beer or stout, and Edith didn't say no to the occasional beer.

  She had one day off every two weeks, and used the free day for doing her laundry, writing letters, and taking walks. Social life was almost nonexistent, and nurses were absolutely forbidden from associating with doctors and other men in the hospital, except in the line of duty. If a nurse so much as sighed in the presence of a handsome surgeon, it was reason for dismissal.

  Nurses at the London Hospital worked hard to keep the wards clean, bright, and cheery. Above is Sophia Ward, named after an eighteenth-century English princess. (The Royal London Hospital Archives)

  Partway into her second year as a probationer, Edith was assigned to three months' emergency service in the town of Maidstone, southeast of London. A terrible epidemic of typhoid fever broke out in the town during the autumn of 1897. Edith was later remembered as the nurse who brought toys to Maidstone's children.

  The location of the London Hospital, shown here in the 1890s shortly before Edith arrived to take her training, placed it among the city's poorest citizens in the East End. (The Royal London Hospital Archives)

  For her third year, Edith was placed on the London's private nursing staff and attended patients in their homes. Back at the London full-time for her fourth and final year, Edith was appointed staff nurse in the hospital's Mellish Ward, where she had the bad luck to work under a bullying senior nurse named Lillian Gough. Edith wasn't happy to be singled out for Gough's harsh criticism, but she turned the senior nurse's treatment into one of the wry jokes she was noted for. She gave Mellish Ward a nickname: Hellish.

  But the person at the London who struck fear into the heart of every nurse was Eva Luckes. From 1880 to 1919, Luckes was employed as the hospital's Matron, the official with the responsibility of training and grading each nurse. Luckes knew her business. She gave lectures on nursing techniques. She had powerful influence with the doctors and administrators at the hospital. And she kept the probationary nurses under such close observation that she felt confident in writing long reports on every woman who passed through the hospital's system.

  The imposing woman in black is Eva Luckes, the often-feared Matron at the London Hospital. The class shown here is from 1892, four years before Edith arrived at the hospital to begin her nurse's training. (The Royal London Hospital Archives)

  Luckes looked and behaved like a younger Queen Victoria. She was plump and bossy. She had strong opinions, particularly about her nurses, and would never listen to a view different from her own. She was often harsh in her judgments, and though it was the last thing Luckes would admit, she could be mistaken in her written assessments.

  Luckes' final report on Edith, at the end of her four years of training, put Edith in a poor light. “Cavell was not a success as a Staff Nurse,” Luckes wrote. “She was not methodical nor observant and she over-estimated her own powers. Her intentions were excellent, and she was conscientious without being quite reliable as a Nurse.” Few of the women at the London came in for generous words from their Matron, but in Edith's case, Luckes got her report spectacularly wrong. Everything about Edith's later career showed her to possess all the qualities that Luckes was unable to detect. If Edith weren't methodical, observant, and reliable, she would never have succeeded as Matron of the Brussels clinic.

  It may have been that Luckes used her blunt reports on the nurses to spur those she criticized so sharply to higher accomplishments. But it's beyond question that Edith admired Luckes as an administrator and used her as the model when Edith later became the Matron in Brussels. Edith seems to have had respect, and even affection, for Luckes. Over the years, she stayed in touch with her by mail, keeping Luckes up to date on her life after the London. Edith's correspondence had a friendly and confiding tone. One letter in July 1901 reported an incident of a man robbing Edith of her money in a London street. Other letters asked Luckes for help in finding better nursing posts. Luckes always responded, and it was she who arranged Edith's first nursing position in January 1901.

 

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