Title : Florence Nightingale's India

 Florence Nightingale's India

World Health Organisation has decided to desig­nate 2020 as the Year of the Nurse and Midwife to mark the bicentenary of Florence Nightingale's

birth. The most famous Victorian after Queen Victoria her­self (BBC 2010), Florence Nightingale is recognised world over as a humanitarian, statistician, social reformer and above all the founder of Modern Nursing and Hospital Ad­ministration. But her interest in India and her contribution to the public of India is not so widely known. Miss Nightingale never visited India but it might sound unbelievable to note that the 'Lady with the lamp' was largely responsible for laying the foundation for Public Health in India. Professor Gerard Vallee of University of Ontario published 'Florence Nightingale on Health in India' wherein Miss Nightingale's concern for India, notably the drainage system and san­itation needs take centre stage. One of the most prolific writers of the 19th century, Florence Nightingale put her thoughts to paper more often than expected and on a wide variety of topics ranging from health, agriculture, climate, native customs, girls' education, famine, poverty, and above all the apathy of British administrators towards the Indian people . An article appeared in the August 1878 edition of The Nineteenth century titled 'The people of India' opens with a very bold and striking statement from Florence Nightingale, "We do not care for the people of India". The article goes further to question the apathy of the British government, "What we engaged to do was to prevent any from dying of famine, what have we done? In many parts one fourth have died!".

Madras Famine' by Sir Arthur Cotton (1803-1899) has a copy of Ms Nightingale's letter to the press which holds the British administration to account for the neglect of the Indian people and the failure to create proper drainage and water management system in India. Almost two cen­turies later in 1999, Nobel Prize winner economist Ama­rtya Sen credited Florence Nightingale for her finding that the famines in British India were not caused by the lack of food in the particular geographical area but by inadequate transport of food, which resulted from the absence of a political and social structure. But then, Nightingale was a remarkable woman with several obsessions — statistics, spirituality, poverty alleviation and environmental sanita­tion were among them. Shashi Tharoor India's Member of Parliament while talking about the British Raj once remarked "Florence Nightingale the legendary British re­former and statistician as well as the founder of Modern nursing said this of Indian famine "the more one hears about this famine, the more one feels that such a hideous record of human suffering and destruction the world has never seen before".

She began her work in 1859 on the health of the Brit­ish Army in India and within no time her work turned from purely army problems to public health issues. She aimed mainly to arouse official and civilian England's interest with the ultimate aim to improve living conditions for the native population of India. She took the help of anyone whom she thought is sympathetic to her cause and that ranged from many of her powerful friends to Queen Victo­ria. When progress seemed slow she wrote what she had to say, not only she shared it with the leaders of England but also had it translated and despatched to those edu­cated leaders of the rural India who could influence their backward brethren towards new ways of thinking.

Indian Sanitary Commission's Report is a formidable document consisting of two bulky volumes containing 1069 and 959 pages respectively. Very obvious that great­er part of this voluminous documents bears the imprint of Florence Nightingale; to start with the filled questionnaires received back from Commanding Officers, Engineering Officers and Medical Officers were sent to Florence Nightingale to compile and analyse. It was said at the time about her compiled report that such a complete picture of India both the military (British) and civilian (Indian native) was contained in no other book in existence. In October 1861, Florence Nightingale was formally requested by the Indian Sanitary Commission to give her observations on the compiled report, a task she completed by August 1862. Her remarks 'Observations by Miss Nightingale' a twenty-three pages document thus became part of the commission's report. This observations could well be termed as one of the most remarkable of Nightingale's works, not only she referred to Indian Hospitals but na­tive customs of India, agriculture, food, water-supply and drainage systems.

In 1863 & 1864 a series of Miss Nightingale's arti­cles appeared in Times on the sanitary needs of India and how Britain was not paying the required attention to the Public health needs of India. In November 1863, Sir John Lawrence was appointed the Viceroy of India, who made it a point to visit Miss Nightingale before he travelled to India. The theme of the talk during their meet­ing was 'Sanitary reforms in India' and ways and means to expedite executing recommendations of the sanitary commission. This meeting was a just the beginning of a series of correspondence between the Viceroy and Miss Nightingale on implementing the sanitary commission's recommendations and the bureaucratic delays in Britain which hinders the progress. The Secretary of State for India controlled the India office in King Charles Street, Westminster which acted as a communicating channel between the Government in India and the Government in London. In order to end the bureaucratic stalemate be­tween the Governments and put the public health needs of India on priority, Florence Nightingale shot off letters to Secretary of state for India and to the members of House of Commons whom she know will be sympathetic to her cause. Some of these letters were laced with sarcasm and point fingers straight at the British administration towards their apathy.


It was Florence Nightingale's untiring efforts and per­suasion that created a Sanitary Department in the India office, which received the annual reports of the sanitary departments and directed to Florence Nightingale. Dr Ha­thencay, the Private Secretary to Viceroy, Dr Hewlett; San­itary officer for Bombay, Dr Cunningham, Sanitary advisor to the Government of India, all frequently corresponded with her. In January 1864, Nightingale with Dr Sirtherland, Dr Farr, and Sir Robert Rawlinson completed 'Suggestion in regard to sanitary works required for the improvement of Indian Stations'. It was the first sanitary code for India, giving details of water supply, drainage, sanitation, hospi­tal and barrack construction. Florence Nightingale wrote to Sir Stafford Northcote, the Secretary of State for India about the establishment of an 'Indian Public Health Ser­vice' cadre in line with the 'Indian Civil Services Cadre' an extravagant idea for the time but remains an unfulfilled dream even one and half century later in 2020.

Largely at her bidding, in 1866, Captain Tulloch was assigned to prepare a comprehensive scheme for laying drains in Madras. When the Tulloch report was ready Flor­ence Nightingale used it for all its worth to get Madras its sewage system. Viceroy Lord Ripon ordered the work to be commenced at once. The work so started progressed at snail's pace for the next 25 years. Miss Nightingale joked, "At Once! It was clearly measured in periods of Indian cosmogony". She said, "cleanliness of houses, of com­pounds and cattle stalls, removal of cattle out of houses, cleanliness of streets, but above all — protecting water from pollution and rain water should never mix with sewage".

It wasn't just Public Health which caught the atten­tion of Miss Nightingale, she maintained correspondence with native Indian leaders and officials on current affairs, specifically Bengal Tenancy Act VIII, Arrears of Rent Realisation Bill 1878, Bengal Rent Law Commission etc. Prasanna Kumar Sen compiled and published 'Florence Nightigale's Indian Letters' in 1937 which provides a deep insight into Miss Nightingale's idea of India. In 1865 Lord Napier was appointed Governor of Madras. Through his wife Lady Napier, Florence Nightingale managed to in­troduce female nurses into Indian hospitals. In the same year, Nightingale drew up some detailed "Suggestions on a system of nursing for hospitals in India". Graduates were sent out from the Nightingale School of Nurses at St Thomas' Hospital, London to start similar schools in India. St Stephen's Hospital, Delhi in 1867 became the first one to begin training the Indian women as nurses.

In June 1877, when South and South Western India were being ravaged by a terrible famine that would ultimate­ly kill millions, a letter to the editor was published in The Illustrated London News. The said letter outlined details of existing system of irrigation (including lengths of canals etc.), value of agricultural produce, and the urgent need for better and increased public expenditure and had half a million more acres been irrigated in each of these districts of Tangore, Godavari and Kistaah; had they been put in effective communication with rest of India by steamboat, canals, the famine would have been nothing comparative­ly. The letter with such intricate details about these rural southern districts was written by none other than Florence Nightingale who never in her life time visited India.


For most part of the last five decades her life, Night­ingale was fixated with the problems of sanitation, water management and public health problems of India. Flor­ence Nightingale's final crusade for the people of India began in 1891 when she was 71 years of age. She wrote to the Secretary for State for India, "The people are poor, without proper sanitation they would not have a good water supply. As they were not fit to work, how could they pay the extra taxation to provide the necessary work under the Bombay Sanitation Act". Even after the launch of Swachh Bharat Abhiyaan, in 21st century, India sees it as an almost impossible task by all its bureaucratic, cultural, geographical, social and economical challenges. Such excuses never found favour with Ms Nightingale who lamented, "There is no country in the world for which so much might be done for India". There is not a country in the world for which there is so much hope, only let us do it!".


1.     Florence Nightingale and Gerard Vallee. Introduction Florence Nightingale on Mysticism and Eastern Religions.' Wilfrid Laurier University Press, 2003

2.     Letter of Florence Nightingale to Rev J Murdoch secretary of the Christian Literature Society July 27 1886

3.     Norman L Johnson, Samuel Kotz. Leading Personalities in Sta­tistical Sciences. From the seventh century to the present 2011; No. 9/10

4.     Nightingale. Florence life or death in India, A paper read at the meeting of the National Association for the promotion of social Science, 1873

5.     Ramanna Mridula. Florence Nightingale and Bombay Presidency. Social Scientist Sep-Oct 2002; Vol 30 (No. 9/10)

6.     Sanitation in India Letter from Miss Nightingale, London. Journal of the Public Health Society July 27 1888; IV: 63-65

7.     Sen Priyanranjan. A Glimpse into the Agitation for Tenancy Reform Bengal'. Florence Nightingale's Indian Letters 1878-82. Sri Gou­ranga Press, 1937

8.     Small Hugh. Florence Nightingale: Avenging Angel, St. Martin's Press, 1998; 1-19

9.     Sriram V. How Florence Nightingale got madras its drains. The Hindu, 8 January 2013

10.   Strachey Lytton. Eminent Victorians. London: Chatto and Windus, 1918

11.   Swenson Kristine. Medical Women and Victorian Fiction, Universi­ty of Missouri Press, 2005


12.   Village Sanitation in India, A Paper for the Tropical Section of the 8th International Congress of Hygiene and Demography at Buda­pest. A pamphlet, pp 8, signed by Florence Nightingale, London August 20, 1894


Author: Mr. Rathish Nair & Mrs. Jyoti Sarin

The authors are: 1. Principal, College of Nursing, All India Institute of Medical Sciences, Patna, Bihar, and 2. Dean, Faculty of Nursing, Maharishi Markandeshwar University, Ambala, Haryana.


Source: The Nursing Journal of India


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