When Florence Nightingale and her nurses showed up in the British war hospitals at Scutari, on the Crimean front, conditions were worse than they had heard: they witnessed filth, infection, disorganization, and an overwhelming case load. Shiploads of desperately needed medical supplies sat in the harbor while men died because some official had not filled out the proper forms. In this environment, 42 percent of the wounded never recovered.

It took all of Nightingale's training and dedication, and then some, to turn things around.

"God spoke to me"

Nightingale was born in Florence, Italy (hence her first name) in 1820 to an English family of ample means. She traveled and attended parties with the "chosen of society" on the family estate in Derbyshire. When she was 16, she received a divine call. "On Feb. 7th, 1837," she wrote, "God spoke to me and called me into his service."

The call was as mysterious as it was audible-what service? Seven years of uncertainty followed. Over family objections, she began "cottage visiting"-taking food and medicine to poor farmers who lived on the family's lands. Then she began to think about nursing; her family was scandalized. In the early 1800s, nurses were considered unskilled laborers and were reputedly drunken and promiscuous. Proper ladies kept a fine house, gave parties, and made brilliant conversation.

In 1844 American philanthropists Samuel and Julia Ward Howe (the author of "The Battle Hymn of the Republic") visited the Nightingale home. Florence asked them, "Do you think it would be unsuitable and unbecoming for a young Englishwoman to devote herself to works of charity in hospitals?"

Dr. Howe replied, "It would be unusual, and in England whatever is unusual is thought to be unsuitable. But I say to you, 'Go forward.' "

She later wrote, after that, "There never was any vagueness in my plans or ideas as to what God's work was for me."

That work did not begin for another nine years. Family objections had to be overcome. Meanwhile she studied nursing, first in books, then by visiting European hospitals, and finally by training at hospitals in Germany, England, and France. She was serving as director of a home for "invalid gentlewomen" when the Crimean War (1854-56) broke out.

When she heard about the deplorable conditions on the front, Nightingale took 38 nurses to see what she could do. She ended up organizing the barracks hospital, including a kitchen, laundry, and clean latrines. She opened windows to let in fresh air and provided supplies by cutting administrative red tape or buying them herself. She provided reading and recreation rooms for the patients, wrote home to their loved ones, and provided a safe way to mail their pay home. The soldiers adored her and christened her the "Lady of the Lamp," after the Turkish lantern she carried on her midnight rounds.

Her efforts brought remarkable results: the death rate dropped from 42 percent to less than 3 percent.

Driven and doubting

After the war, the only thanks she accepted was the establishment of a fund to train nurses. Beset by nervous illnesses (now thought psychogenic), she retired to the life of an invalid.

Now she fought medical ineptness from her apartments, using her pen, prodigious knowledge, and influential friends as weapons. She spoke with the queen of her experience in Crimea and published the thousand-page Hospital Administration of the British Army (1857). She forced the creation of a commission on military health and helped found the army medical college (1859), the first military hospital (1861), and a permanent commission on health and sanitation (1862). She advised the American government during the Civil War, and both sides in the Franco-Prussian war. She wrote many books on nursing, the most famous being her Notes on Nursing (1860). In short, she transformed nineteenth-century nursing.

Nightingale, however, was not content in her accomplishments. Her notes and personal correspondence are filled with self-doubt and despair. She worked others as hard as she did herself. She demanded total devotion to the cause and accepted neither the demands of family life nor illness as excuses. She worked one close associate so hard that he died prematurely.

Though spiritually motivated, she was unconventional in her beliefs, emphasizing mystical devotion to a God of love and to the service of her fellow creatures.

She received many awards and honors. One correspondent once told her, "You might have been a duchess if you had played your cards better." He did not understand that she was more interested in making nursing a profession-and in saving lives.

Kelvin Crow is president of Education Support Services and contributor to the Historical Dictionary of the United States Army (Greenwood)