In this letter, Florence Nightingale outlines her belief that patient health depends on the environmental conditions in which they recover from injuries and diseases. She recommends cleanliness and clean air – in addition to whatever directly medical treatment the patient is undergoing.

At the time she wrote this letter, Nightingale was already a national hero – the legendary ‘Lady With The Lamp’ of the Crimean War. While serving as a nurse in Crimea from 1854 to 1856, she noticed that more soldiers in her care were dying from infectious diseases than were dying from wounds. She thought this was due to overcrowding and malnutrition, but her proposed solutions – better ventilation and better sanitation – were effectively the foundation of modern nursing. A talented mathematician, Nightingale spent the late 1850s proving statistically that a concentration on sanitation and cleanliness in hospitals had a hugely beneficial effect on patient recovery rates. International Nurses Day is celebrated every year on Nightingale’s birthday, May 12.

Transcription of the letter from Florence Nightingale to Edwin Chadwick

Upper Terrace



Sept 8 / 60


Dear Mr Chadwick

I make haste to answer your question as to my experience (as an old nurse) in the 'application of the water cure to incipient consumption,' especially as it regards so valuable a life. 

1. In incipient tuberculosis, [where the object is to avoid local congestion, the water treatment (not as a charm, as Englishwomen take medicine, but as part of a treatment) I have seen to be most effectual, the rest of the treatment being open air during the greater part of the day] (riding or otherwise, according to the patient's strength), bedroom ventilation at night, diet, founded upon improved digestion, the result of the open-air exercise, sometimes gentle gymnastics, much cold water sponging and little wet-sheet packing.