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Florence Nightingale (1820-1910) achieved fame for her leadership of a group of British nurses during the Crimean War. After the war, she dedicated herself to promoting public health. She became one of history's most famous invalids, following a collapse at the age of thirty-seven which left her bedridden for more than ten years.
By carefully resonstructing the chronology of events that led to her breakdown, Hugh Small has produced a new and startling explanation of Florence Nightingale's actions. After describing her unusual upbringing the author compares the conflicting accounts of what really happened in Nightingale's hospital at Scutari, near Constantinople, during the war. By tracing the gradual emergence of information in the war's aftermath, Small shows that there was an official cover-up of a public health disaster. Drawing on recent research by army historians, he shows how the copver-up involved Florence Nightingale in Queen Victoria's conflict with her Government over royal control of the Army. The book sheds important light on the development of both democratic government and public health in Britain. It also shows how a number of myths were subsequently created around Florence Nightingale, which have obscured her major contribution to these developments.
A revealing study of the personality and achievements of Florence Nightingale based on extensive research and unpublished material.
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List of Illustrations (ix)
Acknowledgements (xi)
1. Resolving the mystery 91)
2. Early life (5)
3. War (20)
4. Post-mortem (56)
5. Cover-up (97)
6. Vengeance 9132)
7. Reputation and myth (182)
References (204)
Notes (209)
Index (217)
Review of Florence Nightingale: Avenging Angel
Review Author: Ellen Jordan
Affiliation: University of Newcastle, Australia
Within a few years of Florence Nightingale’s return from Crimea in 1855, a heroic interpretation of her life and achievements had been constructed that survives to this day. On her death in 1910, she also left a huge mass of letters and other documents that has allowed biographers since to explore and challenge the assumption underlying that account that, in the words of the most astute of the challengers, F.B. Smith, “doers of good deeds must necessarily be good in themselves.” Although her first biographer, Cook, refrained from direct challenge, Lytton Strachey used Cook’s documentation of her life to depict her as an egotistical monster driving men like Sidney Herbert and Arthur Hugh Clough to their deaths. In 1950 Cecil Woodham Smith’s lengthy biography reinstated the “heroine” view, but it was challenged in 1982 by F.B. Smith’s depiction of what he calls the “quintessential Nightingale: insidiously unctuous, effortlessly evasive, thoroughly egotistic and iron-hard, glossing a lifetime of deceit and cherished enmities.”
Works on Nightingale in recent decades, notably those by Anne Summers and Monica Bayly, have concentrated primarily on her significance in the history of nursing, but this book by Hugh Small casts doubt on another part of the myth, that her deeds during the Crimean war were in fact good, and then goes on (he has a psychology degree) to use his discoveries to explain those aspects of her personality which Strachey and Smith found so distasteful.
The heart of Small’s argument is his claim that during the Crimean campaign Florence Nightingale believed that the terrible mortality at her hospital in Scutari was the result of the appalling state of starvation and neglect in which the men arrived, and that this seemed to her to be confirmed by the report on army supply completed by McNeill and Tulloch in 1855. In the months that followed her return to England, however, Dr. Andrew Farr’s figures regarding the comparative mortality of the various military hospitals convinced her that there had been something deeply amiss with her own hospital where the death-rate was spectacularly high, and that the fault lay in the inadequacies of sanitation and ventilation peculiar to that hospital. According to Small, as a result “she suffered a spectacular humiliation in front of all those whom she most respected, when she had to admit that she had been wrong about the cause of death at Scutari,” and that “by the time Notes on Nursing was published a large number of influential people knew that her image as the savior of Scutari was a sham.” He claims that the “repressed guilt” that resulted provides an explanation for aspects of her later career which have puzzled biographers: her retreat into invalidism and isolation; her harassing of the dying Sidney Herbert; and her apparent lack of interest in the project of reforming hospital nursing, to which the public had subscribed £45,000 through the Nightingale Fund.
While Small has produced good evidence that Florence Nightingale changed her views on the causes of the medical disaster, he provides little support for his claim that this change affected her personality. Nowhere does he describe a scene of humiliation, or a moment when her insignia as a savior were publicly removed. His account depends entirely on what she “must have” felt, or what those who read her confidential report “must have” thought. His main evidence is that she became a different person in the years after 1857: she destroyed the letters from Farr in which he presumably explained his methods and figures; she changed her leadership style from being a controller of individuals and administrator of institutions to that of an operative running behind-the-scenes campaigns to determine health policy; she turned against the medical profession after having instructed her nurses to act only on doctor’s orders; she lost all faith in hospitals as the proper place to nurse the sick; and her religious writings justified as God’s plan the fact that philanthropists made mistakes. Yet these responses do not really need such an explanation. People can after all change their views on causes and consequently policy without a trip to a personal Canossa. For example, her destruction of Farr’s letters, Small records elsewhere, was part of a general clearing of her papers in 1861 when she thought she was dying. Further, it is quite usual for those who have demonstrated practical ability to move into the policy area, and distrusting doctors in matters of policy is not inconsistent with giving them an authoritative place in the treatment of specific patients. Consider also that in Nightingale’s day hospitals were not highly regarded, but seen as on a par with orphanages and workhouses, places for those whose families could not give them the help they needed in times of crisis. Finally, in her argument on charity and its failures she was only applying to this particular case what her contemporary Frances Power Cobbe called “that Divine law which for ever evolves good out of evil and makes the good durable and the evil evanescent.”
Small’s book nonetheless records the results of some interesting minor detective work. His work in the Panmure archives, for example, has allowed him to substantiate Smith’s picture of this Secretary of War as “a politician in a shaky ministry. . . adept at lying low on contentious questions” (and to add his own gloss of a man seeking to move control from the Queen as Commander-in-Chief to Parliament). This is in contrast to the buffoonish “Bison” who hated “bothers” depicted by Florence Nightingale in her letters and reproduced by Strachey and Woodham-Smith. He even comes up with a further suggestion for Florence Nightingale’s strategic invalidism. Where earlier biographers attribute it to her unwillingness to tolerate the attentions of her mother and sister, her determination to give herself time and space to see only those she wanted to see, and to write the letters and prepare the reports that she saw as crucial to her reform work, Small suggests that illness provided the perfect excuse for not taking up the work the public expected of her: heading and administering a nurse training school, work which would have left her little time for her self-imposed task of lobbying for army and health reform.
On the other hand, these are findings primarily of interest to experts, and would have been much better published in articles in social history journals where the author could assume an audience familiar with the Nightingale literature. As it is, the tendentious central argument is sandwiched between a narrative of the first half of Nightingale’s life with which the specialist is already familiar, and a series of meditations on the issues raised by Nightingale’s reforming projects and her religious beliefs which assume a knowledge of her later career that the general reader will not possess. Thus the book falls between two stools. It does not provide the full coverage of Nightingale’s life required by the general reader, and yet, for the specialist, the significant points are not sufficiently highlighted.
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