Nursing Florence Back to Health

The great Crimean War nurse has been unfairly demonised

Mark Bostridge

“I have enough papers in my drawers to cover Australia,” Florence Nightingale wrote to a friend in 1895 when she was in her mid-seventies. Aside from reinforcing a sense of the sexual innuendo that has adhered to Nightingale’s name ever since Lytton Strachey’s portrayal of her in Eminent Victorians, this statement throws down a challenge to anyone with the temerity to attempt to write about her. It also conceals an in-built trap, namely that the weight of documentary material combined with the length of her lifespan – she lived to the age of 90 – often makes it extremely difficult to speak of many aspects of Nightingale’s life and career with a reasonable degree of certainty.

Oblivious to this problem, the bacteriologist Hugh Pennington recently tumbled headlong into the trap. Initially, in an article in the London Review of Books, and then subsequently on Radio Four’s Today programme, he claimed, with mounting insistence, that Florence Nightingale must be accounted a bad nurse because she never believed in germ theory. In Pennington’s version, to the end of her days, Nightingale continued to assert a miasmatic theory of disease transmission according to which certain airborne poisons, or miasmata, when inhaled into the lungs, generate fever. And she is said to have stuck to this belief, despite all the scientific evidence confirming that germs cause disease, which began to emerge from laboratories in the late 1870s.

In fact, Nightingale began to change her mind about the existence of germs at roughly the same time that other members of the medical establishment were doing so. Robert Koch’s identification of the cholera bacillus in 1883 appears to have been the crucial breakthrough for her. By the beginning of the 1890s, Nightingale was advocating slide lectures showing germs swimming about in polluted water for village communities in rural India.

Pennington is not the first to make this error, nor undoubtedly will he be the last, though the damaging impression this creates, of a mind closed to revolutionary change in conceptualising disease, leaves its mark (if we want an example of Nightingale’s prescience in scientific matters, we need look no further than her support, in the 1860s, for Robert Angus Smith’s pioneering work on acid rain, long before Smith achieved distinction). But such a mistake does raise the wider question, as we approach the centenary of her death next year, with planned national and international commemorations, of why Florence Nightingale, such a towering figure in our history, and one of that select band of historical characters who are instantly recognisable, continues to be so often misrepresented and misunderstood. In 2004, Ferdinand Mount listed just three of the more recent unfounded accusations levelled against Nightingale: that she was a drug addict (a tabloid allegation based on the bromide she was prescribed for use as a sedative during the severe attacks of spondylitis that prostrated her in the decades following the Crimean War); that she was a rabid Tory (in reality she believed, “without irreverence”, that God was a Liberal); and that she was a diehard opponent of women’s suffrage (despite the fact that she was a signatory to the three petitions on women’s suffrage presented to Parliament by J.S. Mill in 1866, 1867 and 1868). Mount observed that the ongoing publication of Nightingale’s Collected Works would establish easily enough that she was none of these things, but concluded there was little doubt that misrepresentation would continue.

In small part, Nightingale herself must take responsibility for our ignorance about her. She was notoriously reluctant to publicise either herself or her causes, colluding in the public’s ignorance about her work. She disliked the “buz-fuz” surrounding her name following her return to England in 1856 as the heroine of the Crimean War. And in the almost half-a-century of active work that remained to her, she displayed a canny recognition of the fact that as a woman she would be able to wield far more decisive influence by working through men behind the scenes than if she were to pursue legally constituted power of her own.

To a much greater extent, though, the tendency to misrepresent Florence Nightingale stems from the way in which her reputation remains in the strange position of being constantly buffeted between two extremes of interpretation, of a myth and counter-myth. The myth, of course, is of the iconic figure of the Lady with the Lamp, the ministering angel who soothed soldiers’ brows on nightly rounds at Scutari. Today, this icon is still very much with us. It receives national sanction in the statue of Nightingale – the first erected in the capital to a woman other than royalty – at the bottom of Waterloo Place. Sculpted by A.G. Walker, the nine-foot high figure carries a Grecian oil lamp rather than the Arab pattern lamp, or fanoos, with which Nightingale would have been familiar (a miniature version of the statue now sits in 10 Downing Street). The lamp iconology is also enshrined in the annual service of commemoration of Florence Nightingale at Westminster Abbey. This occasion takes place on, or around, her birthday – 12 May (International Nurses’ Day) – with the congregation consisting of nursing staff, members of the Red Cross and the military. At the climactic moment, a procession of nurses makes its way to the high altar holding a lighted lamp, symbolising the passing on of knowledge as well as the emergence of the light of humanity from darkness.

Diametrically opposed to this, but possessing almost as powerful a hold on the public imagination, is the counter-myth originating in Lytton Strachey’s famous debunking of Nightingale in Eminent Victorians. What continues to make this essay compelling reading today is the way in which Strachey is torn between admiration for Nightingale’s dominating will and his desire to expose what he regards as the fundamental inhumanity of her power. His portrait of a woman who sublimates her sexual feelings in pursuit of power over men like poor harassed Sidney Herbert, Nightingale’s collaborator in Army medical reform, was deliberately provocative and, for the generations raised on the storybook myth, genuinely shocking at the time of its first publication in 1918.

Subsequent variations on this counter-myth, increasingly frenzied in their attack, frequently infected with an unpleasant strain of misogyny and ever more extreme in the liberties they take with historical truth, have made Strachey’s debunking look positively benign by comparison. The most outrageous example is the story, still prevalent among American nursing students, that Nightingale died from syphilis when, in reality, she expired from old age and heart failure. The strength of the Lady with the Lamp legend is such that for some, it seems, the only way to counter it is with something equally uncomplicated and one-dimensional. And so the pendulum has continued to swing backwards and forwards between the polar opposites of saint and sinner, in biographies, popular and scholarly, in fiction and on stage and screen. On the one hand, we have plucky Anna Neagle in the 1951 film The Lady with the Lamp, insufferably noble as she wafts down the corridors at Scutari. At the other end of the spectrum, there is the character bearing Nightingale’s name in Edward Bond’s surreal 1960s play, Early Morning. Bond’s Florence Nightingale-the true heir of Lytton Strachey’s – has a lesbian affair with Queen Victoria, who rapes her, disguises her sex by wearing a kilt and speaking in a bad Scottish accent and nurses soldiers by providing them with sexual favours.

Perhaps the greatest obstacle to recovering Nightingale as an authentic historical figure is the astonishing scope of her interests and achievements and the sheer scale of the task, both to document them and to place them in a proper contemporary context. It should go without saying that Florence Nightingale was not simply a nurse and that even during the Crimean War she was much more occupied in managing her nursing staff, purveying the hospitals and dealing with bureaucratic incompetence than in nursing soldiers, but as she regularly tops polls to find the most famous nurse, it remains a point worth emphasising. It also throws into stark relief the essential difference between the wartime roles of Nightingale and the Jamaican-born Creole Mary Seacole, the only woman to challenge Nightingale’s position as the archetypal Crimean nurse in the popular imagination in recent years. While Seacole indisputably possessed the far greater practical experience of nursing, dating back to her days of nursing cholera victims in Jamaica, Nightingale had been entrusted with the vital new experiment of introducing female nurses to the military sphere.

The Seacole bandwagon, fuelled by political correctness and a commendable desire to find multicultural role models, shows no sign of halting, and has recently found a new focus in its campaign to erect a statue to Seacole at St Thomas’ Hospital in London. I must confess, though, that my heart did sink on learning that BBC TV’s single contribution to the Nightingale centenary in 2010 is likely to be a drama about the relationship between Nightingale and Seacole. There is no historical drama – the so-called rivalry between the two women is fictitious – and therefore that admirable screenwriter Deborah Moggach will have to invent one.

Historians and biographers should continue to draw attention to Nightingale’s pioneering statistical methods in healthcare, to her influence on hospital design and to her understanding of the pressing need to educate ordinary people in fundamental health care and disease prevention, which she hoped would make hospitals redundant – by the year 2000 – except for the most severe and surgical cases. Nightingale’s great work of spiritual philosophy, Suggestions for Thought, was published in full for the first time only last year. Studying it will help us to view Nightingale less as a latter-day Joan of Arc hearing voices and more as a radical theologian within the Victorian Broad Church movement, preoccupied with one of the great conundrums of her age, how to make religion compatible with science. As 2008 also marked the 60th anniversary of the National Health Service, it was surprising that no one noted what may be Florence Nightingale’s single most lasting achievement: the introduction of trained nurses into workhouses, replacing pauper care, and her ringing enunciation in her “ABC of Workhouse Reform” of the principle of free healthcare provision.

The redesign of the Florence Nightingale Museum, which closes in the autumn to be refurbished in time for the centenary year, will help to focus the debate about a Florence Nightingale for the 21st century. Opened in 1989, in the shadow of St Thomas’, and exhibiting the Nightingale memorabilia guarded faithfully for many years by the Nightingale nursing school attached to the hospital, the museum will undergo a major refit based on designs by a firm of Amsterdam architects, Kossman De Jong. The new setting will be theatrical, utilising lighting and sound, including interactive “iVoices”, to dramatic effect, and allowing, where possible, Nightingale to speak for herself in her own words. An important layer of the exhibitions will concentrate on historical context, permitting the visitor to understand, for instance, the complex process behind the establishment of professional nursing in Britain, demonstrating what Nightingale, the profession’s most significant iconic figure, owed to other, now obscure movements, like the Protestant sisterhoods, in instituting a reformed programme of nurse training.

Myths are all very well and are often too embedded in our culture to shift, but, in the case of Florence Nightingale, what we most need now is a strong dose of historical reality. And recent history can play its part in helping us to understand the more distant past. In the back of my mind, while I was writing my biography of Nightingale, was sometimes the figure of Margaret Thatcher, helping me to understand the vicissitudes of a woman operating in a man’s world. The Lady with the Lamp would have abhorred much about the Iron Lady’s politics, but she would certainly have recognised aspects of its style as akin to her own. So did Mrs Thatcher. In 1989, on a visit to Turkey, Britain’s first woman Prime Minister laid a wreath in the British Crimean War cemetery at Scutari. Afterwards, she spoke about one of the “great figures of history”, who “had had an idea, who knew what she wanted to do and wasn’t going to be put off by anyone.” She was referring to Florence Nightingale, but it’s tempting to believe that she was really talking about herself.

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