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Cholera Epidemics in the 19th Century

The Great Plague of London, 1665

The Boston Smallpox Epidemic, 1721

“Pestilence” and the Printed Books of the Late 15th Century

Spanish Influenza in North America, 1918–1919

Syphilis, 1494–1923

Tropical Diseases and the Construction of the Panama Canal, 1904–1914

Tuberculosis in Europe and North America, 1800–1922

The Yellow Fever Epidemic in Philadelphia, 1793

General Materials

Notable People

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Florence Nightingale, 1820–1910

Florence Nightingale dedicated much of her life to the reform of the British military health care system. Her practices brought tremendous respect to the field of nursing, and she made great strides in the reform of hospital sanitation. Intensely charismatic and inspirational, Florence Nightingale was an internationally influential figure.


Florence Nightingale was born into a prominent English family and received excellent training in mathematics from both her father and James Sylvester, an important English mathematician and contributor to matrix and number theory. Nightingale would go on to frequently use statistics in her work.

In 1854, following a one-year, unpaid tenure as superintendent of the Invalid Gentlewomen’s Institution in London, Nightingale was recruited by Secretary of War Sidney Herbert for nursing service in Scutari (located in present-day Istanbul) during the Crimean War.

The Crimean War was fought from 1853 to 1856 between Imperial Russia and an alliance of France, the United Kingdom, the Kingdom of Sardinia, and the Ottoman Empire. The service of Nightingale and her trained staff of 38 volunteer nurses to wounded soldiers in this war made her famous in Britain. Death rates among soldiers due to hospital infection had been very high, and the experience eventually led her to the conviction that the lack of sanitary practices was the cause. This conviction inspired her passionate work in hospital sanitary reform.

Nightingale is also known for her work addressing and improving sanitary conditions in British colonial India. Her ideas and writings about the necessity of irrigation canals for the reduction of famine played a significant role in Indian health reforms.

Hospital Sanitation and Reform

Nightingale’s work was based in pre-germ-theory ideas about health and disease, and her concepts of illness reflected traditional humoral ideas about bodily balance and imbalance. However, in the 19th century, theories about zymotic, miasmatic, and other environmentally based sources of infection were predominant, and Nightingale took it as self-evident that filth, putrefaction, and decay—and the miasmic emanations they sent through the air—were the causes of individual diseases and epidemics. For the most part, she did not believe that diseases had specific identities, but, instead, believed that they could change from one disease to another. She also resisted the idea that disease could be contagious from person to person. To her, diseases and epidemics were caused entirely by environmental influences; this conviction was central in her evangelical devotion to hygiene and sanitation in hospitals. Nightingale advocated strongly for regular linen changing, adequate ventilation, the frequent emptying of chamber pots, and the regular scrubbing of floors and walls.

When the germ theory was developed after about 1870, Nightingale was skeptical of its importance, and remained convinced that hygienic practices were more valuable for health than knowledge of bacteriology.

Nightingale as Spiritual Communicator

Contributing to Nightingale’s powerful influence in the medical community was her ability to communicate and articulate her ideas effectively. Her understanding of filth and putrefaction not only as the cause of disease, but also as a detrimental moral influence, were part of a holistic 19th-century world view that saw disease and personal conduct as interconnected. A trained nurse’s duties were not merely physical but fundamentally moral and spiritual.

Notes on Nursing and Notes on Hospitals, two of her most widely read works, contain some of the statistical work with which she methodically demonstrated a decline in hospital mortality rates in conjunction with her sanitary reforms. These two works also express a clear moral statement about the role of the nurse and the spiritual duties involved in sanitary practices.


Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. For additional materials on the topic “Florence Nightingale, 1820–1910,” click here or search the collection’s Catalog and Full Text databases.

Web Pages

Concepts of Contagion and Epidemics
Germ Theory
Humoral Theory
Public Health


Beecher–Stowe Family Papers.
Blackwell Family Papers.


International Statistical Congress. International Statistical Congress, Second Section: Sanitary Statistics. London: H.M.S.O., 1860.
Florence Nightingale. Notes on Nursing: What It Is, and What It Is Not. New York: Appleton, 1860.
Florence Nightingale. Notes on Nursing for the Labouring Classes. London: Harrison, 1861.
Florence Nightingale. Notes on Hospitals. London: Longman, Green, Longman, Roberts, and Green, 1863.
Florence Nightingale. Rural Hygiene. London: Spottiswoode & Co., 1894.
Florence Nightingale. How People May Live and Not Die in India. London: Emily Faithful, 1863.


The following sources were used in writing this page.

Rosenberg, Charles E. “Florence Nightingale on Contagion: The Hospital as Moral Universe.” In Explaining Epidemics and Other Studies in the History of Medicine. Cambridge: Cambridge University Press, 1992.
Smith, F. B. Florence Nightingale Reputation and Power. London and Canberra: Croom Helm, Ltd., 1982.


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