Florence Nightingale is a strange figure, both too frequently written about and too little understood.
Mark Bostridge is the ideal assessor – measured, temperately partisan, yet never losing a sense of perspective over this whirlwind of ambition; this astonishing, formidable, and frequently supremely arrogant and irritating woman.
Florence Nightingale was born into a quintessentially Victorian upwardly mobile family of ex-Dissenters. Her father, on inheriting a fortune from an uncle, changed his name and smoothly moved into gentry life. Yet the Unitarian background of good works and intellectual rigour proved useful for Florence – many of her future advisers were first met in the despised female arena of her mother’s drawing-room.
Aged 17, Nightingale received a call from God. Unusually, this call persisted past adolescence and throughout her twenties she attempted, and was not permitted, to learn something of nursing, then professionally a task left to the degraded, the drunken and the poverty-stricken.
Aged 30, she was finally allowed to travel and visit a range of nursing and teaching institutions, interspersed with private study of government blue-books and reports on hospital administration. A year later the Crimean War broke out and Sir Sidney Herbert, a friend from her travels, now the Secretary at War, asked her to take a group of nurses to Scutari. Within a month, she had collected 38 nurses and was ready to become a legend.
Florence’s work in the Crimea has long been debated – were her ‘miasma’ theories of disease (the then-prevalent idea that smells bred illness) a factor in the horrific death rates in the hospital? Was her constant political infighting the source or the solution to poor supplies, shambolic army organisation and mutinously uncooperative medical staff? These are unanswerable questions, but Bostridge examines claim and counter-claim, dispassionately weighing and assessing evidence.
Whatever the case, the horrors were undeniable – out of nearly 100,000 soldiers, 4,000 died of their wounds, while nearly 20,000 were lost to disease.
Nightingale herself was not exempt and, after only six months, on a tour of inspection of field-hospitals, she collapsed with Crimean fever, which Bostridge thinks was probably brucellosis, a bacterial disease with debilitating long-term effects.
Certainly, on her return to Britain in 1856, Nightingale took up the life of a permanent invalid. Once home, Nightingale’s real work was only just beginning.
Within a year of her return she produced an 800-page report setting out her vision for the reform of the Army Medical Service, ‘Notes on matters affecting the health, efficiency, and hospital administration of the British army’. Soon she turned her reforming zeal to hospital design, health and sanitary reform in India, the improvement of workhouse infirmaries, as well as her best-known project, training-schools for nurses and midwives.
For all Nightingale’s interest in hygiene and sanitation, there are only two mentions of Lister, none at all of the shift from miasma to germ theory. Sidney Herbert asked Nightingale to go to the Crimea because she was the most experienced person in hospital administration in Britain, but Bostridge does not highlight the extraordinary fact that this experience boiled down to just over a year at a tiny nursing institution, supplemented by private visits to hospitals and training-schools in Europe, and the study of governmental publications. This was the best the nation could call on.
That Nightingale was remarkable and achieved remarkable things is undeniable; but Bostridge never stands back to give the reader the long view. There is often too much detail.
Bostridge’s work is a sympathetic and vivid recreation of a life at once secluded and lived in the glare of publicity. It will not be superseded for generations to come.