Florence Nightingale (1820–1910) and Sir John Forbes (1787–1861): Neighbours in Old Burlington Street,Westminster

Introduction

Sir John Forbes and Florence Nightingale lived for some three years as neighbours in Old Burlington Street, Westminster ¹ (Figure 1). Their relationship was based on a note from Sir John to Miss Nightingale (FN) expressing his admiration for her practical approach to nursing. ² In her reply dated 23 February 1860, she explains the motivation behind her nursing methods: ‘The great object I had in view was to recall the art of observation, which has, I think, deteriorated, even in my day, under the load of supposed science’. In Biblical tones she continues:

People have eyes and they see not. My conclusions were arrived at by looking at disease simply from the practical side. If people who have Science too, (which I wish I had,) would do the same, how much might not be done for the World’s health! OPEN IN VIEWER

There is no fresh evidence of anything more than a meeting of minds between the Scottish physician and his famous neighbour but a life of FN published recently has brought to light some new aspects to supplement the old. ⁵

Florence Nightingale’s early professional life

FN was born in Florence in Tuscany. She was the daughter of William Edward Nightingale (1774–1874) of Embly Park, Hampshire and it was there that in February 1837 she experienced a divine calling to Christian good works. Following her rejection of a proposal of marriage from the eligible Richard Monckton Milnes (1809–1885) in the summer of 1849, she embarked on a journey on the River Nile during which she had a further auditory hallucination that God had spoken to her. ⁶

Having had religious instruction, but minimal nursing training, at the Lutheran Institution for Deaconesses at Kaiserwerth, near Frankfurt in Germany in 1851 and briefly with the Sisters of Charity in Paris (1853), she became the unpaid superintendent of a hospital for the ‘Care of Sick Gentlewomen’ at No. 1 Upper Harley Street, London in August 1853. Still uncertain of the exact meaning of God’s calling, she volunteered for duty in the Crimean War (1854–1856) and took 38 nurses out to the Barrack Hospital in Scutari (Uskudar) opposite Constantinople. Arriving on 4 November 1854, she reduced overcrowding in wards and improved sanitation; her talents as a redoubtable administrator contributed to a marked reduction in the death rate in the first months of 1855. ⁷

Returning to England in 1856, FN formed an institution for the training of nurses at St Thomas’ Hospital. She pioneered reforms of army hygiene both at home and in India, and innovative improvements in nursing and public health. Her main published work Notes on Nursing (1860) ‘caused a mild sensation’. ⁸

Letters from the Crimea

FN was a prolific correspondent; 300 of her 13,000 letters have survived as primary sources of information and a selection has been published. ⁹ Unpopular with the Army doctors who regarded her as arrogant and interfering, she was nevertheless prepared to work 12 to 15 hours a day on the wards at Scutari. In spite of the terrible conditions, both in the Crimea and at the base hospitals on the Turkish mainland, she preserved her sense of humour and personal insight. Writing home to her father from Balaclava, she asked him to send her out a cuckoo clock which she wished to present to a nursing colleague, adding ‘it must make a noise – not a silvery voice like mine’. ¹⁰

The Victoria Cross, awarded for bravery in battle, was instituted at the end of the Crimean War but it was the amazing devotion to duty of the ‘Lady with the Lamp’ and her sincere wish to improve conditions for the sick and wounded soldiers that caught the imagination of the British public, vowing to espouse the cause of the Army for as long as she lived. ¹¹

London in 1856

On her return to England in the late Summer of 1856, FN determined to implement her plans at home but was delayed as the Whitehall political establishment was away on holiday. She found an ally in Sir James Clark (1788–1870), Physician-in-Ordinary to the Royal Court. Clark had a holiday residence at Birk Hall near Ballater in the Highlands, close to Balmoral Castle. With Clark’s introduction, FN was commanded to attend an official interview with Queen Victoria (1819–1901) on 21 September followed by private talks with her majesty at Birk Hall. Nightingale seized this golden opportunity to obtain the royal endorsement for her nursing reforms ¹² (Figure 2). OPEN IN VIEWER

From November 1856, FN lived in rooms on the upstairs floor of a house next door to the Burlington Hotel, Old Burlington Street, Westminster where she had stayed whenever her family visited London (the hotel was demolished in 1935). ¹³ The rooms at No. 30 Burlington Hotel Annexe became her headquarters for the next three years. She found the building dingy and sometimes used other rooms nearby.

In a letter dated 18 February 1857 she was asked by the Secretary of State for War, Lord Panmure (1801–1874), to record her practical observations on and recommendations for the health of the Army; over the next few months she wrote a lengthy document that extended to 567 pages. ¹⁴ This ‘Confidential Report’ contains very detailed information consisting of facts, figures, letters and statistics written in just six months of intense effort. This magnum opus was an exemplar in providing much needed improvements in military health. FN concluded that hygiene should be the criterion on which all reforms should be based.

After much bickering and bureaucratic delay, finally a Royal Commission was set up in May 1857, headed by her intimate friend Sidney Herbert (1810–1861), later first Baron Herbert of Lea. ¹⁵ FN drew up a list of 10 doctors and lay persons to serve and submitted them to Lord Panmure. Included were her friend and helper Sir James Clark, the confidant of the Queen and Prince Albert (1819–1861) and Dr William Farr (1807–1883), a pioneer medical statistician. ¹⁶ The conclusions of the Enquiry as to the root causes of the ‘Crimean disaster’ and its recommendations for reform (mainly based on Nightingale’s arguments) instigated improvements in the Army Medical Service. ¹⁷ By August 1857, FN’s health was despaired of on account of her spending long hours on her polemical writing and scheming. She often lay all day stretched out on a sofa, worn out by this and by her experiences in the Crimea. One may speculate whether this malady was due to a physical illness or chronic fatigue from her efforts on behalf of the Army.

Illness

Bostridge has written compellingly in favour of chronic brucellosis as the cause of her frequent ‘collapses’ citing, in particular, the severe spinal pain she suffered in December 1861 which fits with spondylitis: this may occur in brucellosis and may be both agonizing and debilitating. ¹⁸ Neuropsychiatric symptoms as well as low-grade fever may occur in chronic brucellosis. ¹⁹ No doubt doctors will argue about the differential diagnosis between a physical illness due to an infection incurred in the Crimea and a psychosomatic cause for her incapacity. It should also be pointed out that at this time (1857–1860) FN lacked secretarial help and that at her own expense she had spent £700 (£26,000 in today’s money) of her modest income of £500 pa on printing. ²⁰ The nadir of her illness took place on Christmas Eve 1861; overcome by grief with the accumulation of deaths of her closest friends including Sidney Herbert in August, Arthur Henry Clough (1819–1861) in Florence in November and Prince Albert at Windsor in December, she collapsed and, for several weeks, lay at death’s door. By the end of January 1862 she was convalescent and was persuaded by her father to move to rented rooms in Hampstead. ²¹ This was the first of several changes of residence although none was entirely suitable. By 1865 she moved house again to Mayfair at No. 35 South Street (renumbered to No. 10 in 1878), off Park Lane, and remained there until her death. ²²

Dr John Forbes and Florence Nightingale

In 1840 Dr John Forbes, best known for his translations into English of the new techniques of mediate percussion of the chest as promulgated by Auenbrugger in 1876 and of stethoscopy by Laennec in 1819, moved from Chichester to No. 12 Old Burlington Street. Fortunately, Forbes was appointed Court Physician to the Royal Household in February of the following year and for his services he was Knighted in 1853. ²³ Forbes was sole editor of the British and Foreign Medical Review from 1839 to 1847. ²⁴

In 1857, just before the decline in his physical health, Sir John published a small volume based on his favourite theme of the vis medicatrix naturae. ²⁵ In his introduction, dated ‘London, 1 February, 1857’, Forbes makes it clear that his aim was to set out the case for the curative powers of nature and the avoidance of polypharmacy, especially by junior doctors.

Unfortunately, Forbes’ opinions clashed with the London medical establishment and contributed to the failure of his Review in 1847. ²⁶ But in Of Nature and Art… Forbes had emphasized that the practice of medicine must combine science and art, a view echoed in the letter to the Scottish physician from Florence Nightingale of February 1860. ²⁷ Similarly, in her Notes on Nursing, published in the first week of January of that year, FN refers to illness as being a reparative process instituted by Nature and consistent with ‘God’s Law’. ²⁸ She fervently believed that a nurse’s role in healing sickness lay in performing basic care at the bedside. ²⁹

Discussion

What is the modern reader to make of FN’s letter to Sir John? This opens effusively:

Nothing has given me half so much pleasure as a note from you about my little Nursing book. That you, to whom the world is so much indebted in the matter of its health, should endorse it with your imprimatur is a very great satisfaction to me. ³⁰

FN was capable of forming strong and sometimes emotional relationships with men, for example Sidney Herbert, ³³ and with other women. ³⁴ Perhaps it was a providential escape for Forbes that fate decreed that the pair never met as neighbours despite living within a short distance of each other?

FN visited hospitals in Dublin in August 1852 but was recalled by Sir James Clark due to the psychosomatic illness of her sister ‘Parthe’ (1818–1890). ³⁵ By coincidence, the recently widowed John Forbes also visited Dublin in the same month en route to travelling throughout Ireland to see the effects of the terrible famine years of 1845–1847 ³⁶ but their paths never crossed.

Epilogue

Sir John Forbes died peacefully at Whitchurch-on-Thames on 13 November 1861 and in St Mary’s Church a plaque placed by his son, Alexander Clark Forbes, commemorates him. It is inscribed with a tribute to his father’s memory and concludes ‘He passed through life without reproach, and died as he lived, an honour to his noble profession’. ³⁷

Florence Nightingale’s health gradually deteriorated so that by 1906 she was suffering from blindness and dementia. She was awarded the Order of Merit in November 1907 but a ceremony was not possible for her.

The Jubilee of the opening of the first Nightingale Training School at St Thomas’ Hospital, the forerunner of many in this country and in the USA, fell on 24 June 1910 but she was unaware. The Angel of Death approached slowly and on 13 August 1910 she fell asleep and did not wake. ³⁸