There have been many biographies of Florence Nightingale, most of which tend to be either hagiography or calumny; no middle ground. She had that effect on people during her lifetime, too. The present one at least tries to be even-handed, in presenting in great detail the family background and circumstances which made Nightingale what she was. Unfortunately, this means that we are more than half-way through the book before she even gets to the Crimea. The point about Nightingale was that she was not really a nurse. It so happened that nursing was what caused her to flee the suffocating family nest, but her actual clinical experience was very brief and hardly representative. It did, however, lead her to her true vocation: as healthcare system designer, manager, administrator and reformer, not just of the Army Hospital system but of public hospitals (yes, they did exist pre-NHS) in the UK and the Empire.
It helps not to think of her as a woman, in the sense of an ovary-driven creature, emotion-led. Like all the great Victorian reformers, she got on much better with humanity in the mass than she did with individuals. She had as equipment only the ordinary education given to upper-class Victorian girls, which is to say, no education at all in our eyes; nevertheless she was blessed (or cursed) with ample robust common sense. This, plus the ability to see what was in front of her, unlike the War Office and Army medical establishment, led her to promote ventilation, nutrition and sanitation as the then (ie pre-antimicrobials) vital elements in hospital care. So she didn't believe in germ theory. (Couple of dates: Pasteur first demonstrates infection via microbial invasion: 1862. Nightingale's clinical nursing experience ends: 1857.) Very many eminent medical gentlemen didn't believe in it either: that's what it was, a theory, for many years. We take it for granted now, but it is unhistorical to beat Nightingale over the head for not accepting it then. But she had the faults of her virtues.
She had to be forcibly prevented from applying her "fresh air is best" policy to the Army in India, where the malaria-carrying mosquitoes would have loved it, not realising (and she had no personal knowledge of conditions in India) that different distempers need different remedies (another date: proof of cause of malaria, 1898). She alienated many would-be supporters and colleagues when she let her exasperation with slower minds and male patronage lead her into tantrums and abuse. She ended up a permanent and reclusive invalid for the last 53 years of her long life, a massively productive period professionally but rather skated over in the present book. Again, this withdrawal has occasioned many theories, in which the words psychosomatic, repressed and hysterical tend to recur; nor is the present biographer (who at least promotes a physical cause: brucellosis) guilt-free of complicating what seems to me to be a simple story.
The only way that Nightingale (unlike a man) could be free to pursue her work untrammelled by demands to be a dutiful daughter, pay teatime visits, play bridge, achieve flower-arranging, was to pre-empt these demands by chronic illness. It was the only respectable way. Nightingale invented modern nursing administration and organization. Her idea was one person (Matron) with overall responsibility, backed up by a range of specialist Assistant Matrons, for all matters pertaining to patient health and comfort: housekeeping in other words: laundry, food, cleaning, portering, nursing including nurse training. Medicine she left to the doctors. For fifty years now that system has been chipped away, with no-one person holding the buck any more, with housekeeping services contracted out to the lowest tender, untrained "care assistants" replacing nurses on the wards. Was Nightingale's vision so wrong?
536pp. paperback; illus; index and notes
