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Two hundred years ago a girl was born to the wealthy British Shore family. A life of servants, riding and royal galas awaited her and her year-old sister Parthenope. Parthe for short, thank goodness. Governesses raised the girls until their father selected a school. But the quality of education for girls disappointed him. He brought his daughters home so he could teach them himself.

Parthe would rather ignore the books and apply herself to traditional skills, such as sewing, music and flower-arranging, until ownership of her life would be legally transferred in marriage from father to husband.

Florence Nightingale - from the National Library of Medicine

The younger sister, nicknamed Flo for her parents’ beloved Florence, Italy, preferred books. For Flo, her father designed a curriculum built on Greek, Latin and math. She consumed it all. The ancient languages made her multilingual, which would be valuable years later. She especially took to math and its new branch called statistics. When the teenaged girls toured the Continent with their parents, Parthe couldn’t keep her eyes off the palaces, gilded carriages and young men in uniform. Flo, meanwhile, flipped open her always-handy notebook and recorded the numbers of buildings, fountains, trees and birds.

When the sisters joined the social circuit, Parthe was a natural. Flo resembled her father: tall, thin and serious. At parties, she towered over most boys, looked pale and was a bit standoffish. She longed for her rooms where she could read in peace. But Flo did her best at formal gatherings and used her statuesque presence to advantage. She attracted suitors less with looks than with her clever wit, which she usually kept hidden. At 17, a young member of drawing room society proposed marriage. Flo made the unheard-of decision to reject him. Aunts and cousins reacted with anger, frustration or bemusement. Her mother almost fainted.

But something beyond marriage tugged at Flo. As she rode carriages to and from parties, she noticed squalid slums and saw misery on faces. When she traveled the Continent, its rebellious activism against social injustices inspired her. She began devouring books on England’s Industrial Revolution and how it led to poverty for many. She was especially moved by the scenes of starving orphans as young as five tied to backbreaking days in factories and mills.

The suffering of England’s homeless and destitute just outside the estate walls haunted Flo. She fell into periods of deep depression and isolation and began to disdain the notion of the idle rich. But family responsibilities remained. Flo filled her social calendar but also kept an eye on Europe’s politics, slavery abolitionists, women’s suffrage and child labor reforms. Her social standing brought her into literary circles, and when she was 22 the poet Richard Monckton Milnes asked her to marry him. This time she struggled with the choice. Would Flo choose the acceptable route into marriage or follow a path she couldn’t yet define, but one which had a strong pull on her?

* * *

On a November night in 1854, a rowboat carrying Flo and 38 nurses crossed the Bosporus Strait in a blinding rainstorm toward Scutari on the Black Sea. They squinted at a castle-like hospital on the top of a bluff.

Twelve years earlier, Flo had declined Milnes’ marriage proposal and began pursuing a career that for women did not exist. After sending Milnes packing, Flo volunteered to take medicines, blankets and food to a poor village nearby. An idea came to her. She asked the village doctor how to go about studying to be a nurse. But nursing school wasn’t a thing. Nurses, unpaid, held a patient’s hand until a doctor, a man, arrived to save the day. The doctor dismissed Flo’s impossible idea. Crushed, she became reclusive, lost weight and was often sick. Her family didn’t give it much thought. Travel, they said. See museums and ancient ruins.

On the continent she visited poorhouses and befriended aristocrats. Many shared her concern for Europe’s homeless children and women, who had no access to healthcare. Flo returned home and began studying the procedures in English hospitals. She traveled Europe to observe surgeries and study doctors’ reports. Flo cobbled together her own training as a nurse qualified to do more than holding a hand or dabbing sweat off a brow. She most wanted to be a nurse for society’s neediest and forgotten. When her family heard it, her parents turned dumbstruck. Parthe went hysterical.

On her own, Flo built a career. She was head of London’s Institute for the Care of Sick Gentlewomen when the Secretary of War called. Britain and France were fighting Tsarist Russia in the Crimea. That call led to a boatful of women on the Bosporus in the dead of night.

The dank and fetid scene inside Barrack Hospital stunned them. Fifteen-year-old soldiers screamed in pain surrounded by filth, vermin and exhausted doctors. The place lacked fresh bandages, instruments, clean blankets, safe water. Flo set the nurses to work. They upgraded cleaning, recordkeeping, food (she called her contacts to bring in a chef) and surgical rooms. Flo arrived first each day and was last to leave. Every night she carried her lamp up and down rows of sleeping soldiers, checking each. Doctors groused about having to wash their hands and, worse, take advice from a woman. But with her physical presence, stern resolve and friends in high places, Flo made sure they toed the line. She voiced the wry opinion that a hospital’s job is to make patients well, not sicker.

The wounded came in faster than doctors could treat them. Flo watched one doctor set aside five soldiers to die because their injuries were too serious for the time and effort required of him. She grabbed another nurse and together they spent the night keeping the men alive. When the doctor saw them in the morning he decided maybe he could save them after all.

In addition to better cleanliness, Flo introduced post-treatment follow-ups to tell doctors if their ministrations had helped or not. She compiled it all in the 1859 Notes on Nursing, which revolutionized medical recordkeeping and hospital sanitation. The author’s name appeared on the cover, but it wasn’t Flo Shore. Her family had taken a different name years earlier. The author was Florence Nightingale.

Nightingale went on to make nursing a profession with standardized training, uniforms and a code of ethics. Every nurse today recites the Nightingale Pledge at graduation. Washing hands to remove germs was once viewed as radical. Now, it’s the first basic step in germ control. Nurses still follow Nightingale’s footsteps. When they see something that needs doing, they get it done.