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Historical figure

The common soldier's saviour, the ideological leader of nursing reform, and a pioneering social reformer besides, Florence Nightingale (1820 - 1910) is arguably the most famous Victorian after Queen Victoria herself. She belongs to that select band of historical characters who are instantly recognisable: the Lady with the Lamp, ministering to the wounded and dying - albeit by the light of a Grecian lamp rather than the historically accurate, but less romantic, folding Turkish version - is an image permanently imprinted on the British national consciousness. As a woman, too, she is almost unique in that her fame and legend elude the normal categorisations in which women up to her time had achieved immortality: she is neither queen, nor courtesan, beauty nor artist.

She is a nationally sanctioned heroine. Until very recently (2002) she was the only woman, alongside the male personalities of Newton, Wellington and Dickens, whose image had ever adorned our paper currency. For nearly 20 years (between 1975 and 1993) her portrait, adapted from Barrett's painting of Nightingale at Scutari, The Mission of Mercy (now in the National Portrait Gallery, London), could be found on the £10 note. In short, as the historian Raphael Samuel once wrote, she is one of the 'stock images' of our island story.

Why then does her true significance continue to elude us? Generations have been raised on the sentimentalised story of her time as a nurse during the Crimean War, fighting the obstructive army and medical officials to ensure that the sick and wounded were nursed in civilised conditions, and with proper care. But comparatively few of us are aware of the importance of that story's sequel: of how, from her sickbed, Nightingale attempted to supervise the modernisation of nursing, together with advising governments on army reform, sanitation in Britain and India, and hospital design.

Romantic myth

A large part of the problem, of course, is the persistence of the romantic myth about the ministering angel of Scutari. Few individuals in their own lifetime - and in such a comparatively short period of it, too - have achieved the level of adulation, fame and stature that Nightingale did. By the age of 35 she had already been the object of the most extraordinary outpouring of adoration. She returned from the Crimea in 1856 and chose to live and work for the next half-century in almost complete seclusion, a decision which only further cemented her legendary status.

The myth has to a very large extent obscured the fact that Nightingale's Crimea experience was only the prelude to her more important postwar career. It has prevented us from assessing accurately her achievement at Scutari; when examined closely, the accepted doctrine that she saved soldiers' lives in her hospital suddenly dissolves before our eyes. And it has also allowed us to forget that Nightingale's priority on returning from the Crimea was not the reform of civilian nursing in Britain, but rather a thorough overhaul of the health of the army in peacetime.

It is arguable that the British Army owes far more to Nightingale than nursing in this country does. True, as the standard-bearer of nursing, she played a decisive role in transforming nursing into a profession for single women of impeccable moral standards; but her actual strictures on hospital care were part of a much broader attempt to formulate a policy on public health through the adoption of better sanitation.

Personal archive

Another part of the problem in coming to lasting conclusions about Florence Nightingale is the sheer scale of the materials involved. The enormous collection at the British Library - the second largest personal archive after Gladstone's - is just the tip of the iceberg. At least 14,000 letters are known to survive, along with 147 printed publications, and hundreds of private notes and memoranda.

The scale of the material is one reason why, up to now, there has been no authoritative, fully documented biography. Sir Edward Cook's two-volume Life, published in 1913, is still the best biography, despite the popularity of Cecil Woodham-Smith's Florence Nightingale, which appeared in 1950. Future biographers will be helped by a large-scale project which begins publication this year (2002). Dr Lynn McDonald's projected 16-volume abridged edition of Nightingale's works will help to clarify the reformer's thoughts on such diverse subjects as religion, the army, the use of statistics (of which she was a pioneer), hospitals, women, nursing education, Poor Law reform and so on.

The weight of material combines with Nightingale's long life - in 60 years of active life she understandably changed her mind many times - making her a difficult person to pin down on a definitive point of view. And she remains, above all, a creature of paradox: a woman whose work and standing signified much for the idea of women's rights, but who heartily disliked the women's suffrage movement, and found it almost impossible to work in co-operation with other women; a woman who spent much of the decade and beyond, after her return from the Crimea, confined to her bed as a chronic invalid (she is now though to have suffered from a bacterial infection, brucellosis, picked up in the Crimea), but who nevertheless worked with an almost demonic energy in the areas of reform she was interested in; a woman who claimed to dislike the 'fuzz-buzz' about her name, but who manipulated her fame to masterly effect for her own ends.

Early life

Florence Nightingale inherited a liberal-humanitarian outlook from both sides of her family. Her mother's father had sat in the House of Commons for almost half a century as an abolitionist, while Florence's father, William Edward Nightingale, who had inherited an enormous fortune from his uncle, fought hard for the reform of Parliament before settling down to the life of a country gentleman on his estates at Lea Hurst in Derbyshire, and Embley Park in Hampshire.

Florence, born in the city of that name in 1820, and her older sister Parthenope, benefited from their father's advanced ideas about women's education. They studied history, mathematics, Italian, classical literature and philosophy, and from an early age Florence, who was the more academic of the two girls, displayed an extraordinary ability for collecting and analysing data which she would use to great effect in later life.

Although, by early-19th-century standards, Nightingale had been given a man's education, she was confined by the conventions of the day, which decreed that, as an upper-middle-class woman, she should spend most of her time in frivolous pursuits and domestic routines. Florence struggled hard to find fulfilment, against the opposition of her family. She felt frustrated by the suffocating existence which denied her the use of her intelligence and energy and which, on several occasions, drove her to the edge of breakdown. 'My present life is suicide', she wrote in 1850. 'I have no desire but to die.' Believing that she heard the voice of God, calling her to his service, she rejected marriage (including an offer from one persistent suitor, the writer and philanthropist, Richard Monckton Milnes), and decided that her destiny lay in nursing.

Florence's family, who shared the prevalent view that nursing was a disreputable occupation for someone from their background, were appalled at her decision, and bitterly opposed her. In 1845 her parents refused to allow her to nurse at Salisbury Infirmary, but Florence did manage to spend two periods at the Institute of Protestant Deaconesses at Kaiserwerth in Germany, and later visited hospitals in London, Edinburgh, Dublin and Paris, amassing details of hospital conditions and nursing methods. Finally, in 1853, she won her independence - and a small income from her father - by being appointed Superintendant of the Hospital for Invalid Gentlewomen in Harley Street.

Crimean mission

The torture of Nightingale's early years was undoubtedly responsible for the streak of steely ruthlessness that had entered her character. She was graceful, slender, appealing to look at, and she could be charming when the occasion required; but underneath she had an unbreakable resolve, and also happened to possess one of the great administrative minds of the 19th century. Her sister Parthenope, with whom Florence had a difficult and ambivalent relationship over many years, once wrote that Florence was 'a shocking nurse'. She 'has little or none of what is called charity or philanthropy, she is ambitious - very, and would like... to regenerate the world... I wish she could be brought to see that it is the intellectual part that interests her, not the manual.'

Nightingale seized the moment when it came. In 1854, a unique opportunity presented itself when Sidney Herbert, the Minister at War, appointed her to superintend the introduction of female nurses in the Crimea and to lead an expedition of 38 women to take over the management of the barrack hospital at Scutari, a large village on the Asian shore of the Bosphorus.

Herbert had been responding to public outrage at reports in The Times of the suffering of the common soldier caused by the incompetence of the British Army commanders. It was vital, both for the future of the government and for the cause of nursing in Britain, that Nightingale succeed.

Ostensibly she did, and in so doing scored an enormous propaganda victory. In the midst of 'appalling horror...steeped up to our necks in blood', she created order out of chaos. She and her nurses cleaned and equipped the hospital, introducing vital supplies that had been withheld from the sick and wounded, fighting the obstructive army medical corps, and earning the everlasting respect and affection of the common soldier.

Hard lessons

But if one looks at the historical record more carefully, one begins to realise that, despite Nightingale's work at Scutari, the death-rate among the soldiers did not begin to fall; on the contrary, it began to rise. Historians are now waking up to the shocking truth that the death toll at Nightingale's hospital was higher than at any other hospital in the East, and that her lack of knowledge of the disastrous sanitary conditions at Scutari was responsible. During her first winter at Scutari, 4,077 soldiers died there, ten times more from illnesses such as typhus, typhoid, cholera and dysentery, than from battle wounds. Conditions at the hospital were fatal to the men that Nightingale was trying to nurse: they were packed like sardines into an unventilated building on top of defective sewers.

As Hugh Small, author of a recent study of Florence Nightingale in the Crimea, has written, this pioneering woman was effectively presiding over 'a death camp'. A sanitary commission, sent out by Palmerston's government in March 1855, almost six months after Nightingale's arrival at Scutari, flushed out the sewers and improved the ventilation, thereby dramatically reducing the mortality rate. However, Nightingale herself continued to attribute responsibility for the high number of deaths to inadequate nutrition and supplies, and to the army's sending of men across the Black Sea to Scutari when they were already half-dead from exposure.

It was only on her return to Britain, when she began collecting evidence to present before the Royal Commission on the Health of the Army, that Nightingale changed her mind, reaching the painful conclusion that most of the soldiers at her hospital had been killed by bad sanitation, due to her ignorance. She had helped them to die in cleaner surroundings and greater comfort, but she had not saved their lives.

Final years

This is a shattering blow to the myth of the Lady with the Lamp, but it was a discovery which drove Nightingale to preach a gospel of fresh air, cleansed drains and public health, for the rest of her campaigning life. She succeeded in reducing unnecessary deaths in the Army during peacetime, before turning her attention to nursing and introducing sanitary concepts into hospitals.

Myths are often obscure, but they can also help spread important change. Such is the case with Miss Nightingale. However, history has an important duty to recover the reality from behind the legend. Benjamin Jowett, Master of Balliol College, Oxford, was perhaps saying something similar when, in a letter to Nightingale in 1879, he observed:

'There was a great deal of romantic feeling about you... when you came home from the Crimea. And now you work on in silence, and nobody knows how many lives are saved by your nurses in hospitals... how many thousands of soldiers... are now alive owing to your forethought and diligence; how many natives of India... have been preserved from famine... by the energy of a sick lady who can scarcely rise from her bed.'

Find out more

Read on

Florence Nightingale, Avenging Angel by Hugh Small (Constable, 1998)

As Miss Nightingale Said... edited by Monica Baly (Scutari Press, 1991)

Ever Yours: Florence Nightingale, selected letters edited by Martha Vicinus and Bea Nergaard (Virago, 1989)

Florence Nightingale; Reputation and Power by FB Smith (Croom Helm, 1982)

Florence Nightingale by Cecil Woodham Smith (Constable, 1950)

The Life of Florence Nightingale by Sir Edward Cook (Macmillan, 1913)

About the author

Mark Bostridge is the author of Vera Brittain: A Life (1995), and the co-editor of Letters From a Lost Generation (1998), which he also adapted for an acclaimed drama series on ´óÏó´«Ã½ Radio 4. His book, Florence Nightingale: the Making of an Icon, is the first fully documented biography of this pioneer of the nursing profession, and is published by Penguin.