Florence Nightingale: the Woman and Her Legend
One of Florence Nightingale's first cousins, a "taboo" cousin, was Barbara Bodichon, who was virtually the founder with Emily Davies of Girton College, Cambridge, the first of all the Oxford and Cambridge women's colleges. She was taboo because she was one of the five illegitimate children of Florence's uncle Ben Smith, her mother's only brother, a misfortune that also prevented her membership of the governing body of Girton.
Florence probably never met her; but they would have had much in common. Florence's determination and compulsive energy were first shown in her abhorrence of the futile life she was supposed to lead as a daughter at home. The same passion inspired Emily Davies (ten years her junior) and Barbara Smith. Their driving principle was not the rights they thought women should be granted, but the waste of talent and damaging frustration they suffered, if they could not be educated alongside and, indeed, in competition with men. Florence Nightingale in fact received a remarkable education, not only in ancient and modern languages but also in mathematics, from her father, William Nightingale. Yet what she wanted was the chance to work. At last, despite the fierce opposition of her mother and elder sister, Par thenope, she simply left and went to train and then work as a nurse.
Work was quite literally her religion: like General Gordon, who later became one of her heroes, she found God only in action. She was a Christian Soldier. The church, of whatever denomination, irritated her. In 1857 she suggested in a letter to her father that God stops fever not in answer to prayer, but by his work being carried out "in a drain, a pipe tile, a wash house".
The Crimean War, and Florence's work as a nurse in the ghastly conditions she found at the Scutari hospital were her great opportunity. Bostridge is highly persuasive in describing and analysing her own ambiguous attitude to her astonishing fame, and to the saintly image, first published in the Illustrated London News in 1855, of the Lady with the Lamp. She certainly then acquired and always retained her admiration and sympathy for fighting men as well as her insistence on the individual and, as we might say, "caring" aspects of nursing. She was full of scorn for the ladylike and condescending nurses who came out to the war following her rise to fame, and there was fierce infighting among the different parties. But she later strongly opposed professional registration for nurses. It is not hard to imagine what her loathing would have been for the conversion of nursing into an academic dis cipline, and the disappearance of Matron from the wards. However, she was also fanatically devoted to the theory that morbidity was caused by lack of hygiene, and that if sanitation and ventilation were improved and hospitals properly designed to ensure this, then hospitals themselves would become largely redundant.
In many ways her extraordinary intellectual passion was devoted more to public health than to day-to-day care of the sick, more to the needs of the army than to the welfare of individual soldiers; and, if she had lived a century later, she would probably have been a civil servant (or perhaps a politician) rather than a nurse, or even a doctor. (She had a low opinion of the medical profession and did not approve of those pioneering near-contemporaries who became doctors.)
One of the most fascinating aspects of this absorbing biography is the account of the years immediately after the Crimean War. Florence had contracted a severe fever before returning home, and she remained an invalid for the rest of her life. This was no Victorian hypochondria, but a severe form of brucellosis, which used to be known as undulating or Malta fever. Among its symptoms were spondylitis, an inflammation of the spinal cord which is acutely painful. Her symptoms practically disappeared in the last day of her life; but for most of the period of her greatest influence she was unable to leave her room (though she frequently moved house) and was in constant pain. The demands she made on her family were intense and she was, not surprisingly, often irritable, unreasonable and quarrelsome.
Nevertheless it is astonishing to realise the power she wielded. First, she was largely responsible for setting up the Royal Commission to enquire into the state of the army's medical provision. She wrote a ceaseless flow of letters to ministers, and she wrote up her own ideas and experiences in the form of a long pamphlet (Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, 1858). She was understandably infuriated by what she thought unnecessary delay and prevarication on the part of the government, but when at last the Royal Commission was set up, its terms of reference, in accordance with her wishes, were broad enough to encompass the whole Army Medical Department, including training, pay and conditions, as well as the design of hospitals and barracks. The story of her manipulation of the three men most deeply involved in the work of the Royal Commission inevitably raises the question of whether, if she had been able to be a member of the commission (or even its chairman), or had personally given evidence to it, she would have exercised more or less power. Probably it would have been less.
She had her huge reputation as a living saint to lend authority to whatever she said to the actual participants, and she also had the power of being an invalid, not to be crossed. Above all, she did not have to conform to the normal conventions of committee membership, the conventions of not talking too much, not seeking to influence the course of the deliberations by private letters and other machinations. There was undoubtedly something of the civil servant (a proto-Evelyn Sharp, perhaps) about Florence, but she had the advantage of not having to abide by the rules. No civil servant could behave in quite such a tyrannically self-absorbed way. And her power was scarcely less formidable later, when it was directed, at the time of the Mutiny, to public questions in India.
Bostridge confesses that a biographer of Florence Nightingale is likely to be overwhelmed by the quantity of original material he has to organise and interpret, including three large collections of letters and notes (though by no means all the letters were preserved) as well as secondary sources. He has produced a masterly work, sympathetic but even-handed, and enormously enjoyable to read.
As the title of his book suggests, Bostridge is concerned not only with the Nightingale life, the historical events, but also with the Nightingale mythology, an equally rewarding topic. In his final chapter, one of the most enjoyable, he traces the varying fortunes of the mythological heroine. As a small child, I was myself brought up on A Nursery History of England, with its lovely George Morrow illustrations, in which Florence's ward is shown as light and airy, and she has no need of a lamp. Her entry in the History ends with the words "the poor soldiers loved Miss Nightingale very much, and the English people have always been proud of her". Not so. Lytton Strachey's essay in Eminent Victorians (1928), though not totally debunking, was nevertheless influential in creating the idea of Nightingale as domineering egocentric, full of a disagreeable religiosity. Feminists have also regarded her as an obstacle to the nursing profession. Bostridge allows us to make up our own minds.
In doing so, he makes it impossible for the reader not to be struck by the continuing contemporary evils to which Florence was most passionately opposed: "the shameful neglect of British troops injured in Iraq and Afghanistan by the government at home" (Bostridge's words); and the appalling morbidity in our hospitals, whose lack of adequate sanitation makes people afraid to be admitted to them. Perhaps we need a new incarnation of Florence Nightingale, with all her uncompromising and uncomfortable singleness of purpose.
My only complaint about the book is that St Thomas' Hospital is not allowed its own eccentric spelling.
Baroness Warnock was Mistress of Girton College (1985-91)