BIOGRAPHY: Florence Nightingale: The Woman and her Legend by Mark BostridgeViking, 645pp. £25
RECENTLY, AN organisation called Stop Infections Now was launched in Dublin to campaign against hospital-acquired infections. The driving force behind the campaign is Dr Teresa Graham, who lost her husband to MRSA some years ago, and has a lot to say about the provision, or lack of it, of proper hygiene standards in our hospitals. The idea of maintaining hygienic conditions in hospitals owes a great deal to Florence Nightingale, who in her extremely influential Notes on Nursing, published in 1860, singled out cleanliness, ventilation and, where appropriate, isolation, as key components of recovery for the sick. Here we are, 148 years later, still apparently failing to absorb the lessons she taught us.
What is a nurse? This is the question Nightingale asked at the beginning of Notes on Nursing, and it remains pertinent. Most of us have had the experience, whether on our own behalf or that of a loved one, of the empathetic, caring, wonderful nurse who made all the difference at crucial stages of ill health or recovery. Most of us have also experienced the careless, unpleasant, downright dangerous nurse who had to be circumvented with great skill. In other words, nurses are like the rest of society, some marvellous, some dreadful, most competent, efficient and caring.
Nursing is now a profession with training up to postgraduate level. It is fair to say that Florence Nightingale played a hugely significant part in the establishment of proper training for nurses in Britain, and by extension in the British Empire. Before her interventions in the mid-19th century, nurses who were not members of religious orders were untrained, badly paid, often drunk, and probably a danger to their patients. Dickens's Sarah Gamp exemplified the stereotype of the time.
NIGHTINGALE WAS BORN in 1820 into a family that was involved with radical causes, such as the abolition of slavery, repeal of the Corn Laws, women's education and parliamentary reform. She was closer to her father than her mother, who was socially ambitious and wanted her daughters to marry well. From an early age, Florence displayed intelligence, determination and religiously inspired idealism, and fought a long-running battle with her family to be allowed to live her life as a single, dedicated public servant, turning down a number of advantageous proposals of marriage. She always resented the obstacles they placed in her way, and wrote about the family as a structure detrimental to women's self-fulfilment, in highly disparaging terms.
Having spent a year as superintendent of a "Home for Decayed Gentlewomen", as her aunt called it, Florence was faced with the opportunity that transformed her life, made her a celebrity, and gave her unparallelled influence in the highest reaches of government. The Crimean War, which began in 1853, exposed the vicious shortcomings of the British army with regard to the health of its soldiers. Peace had reigned since the end of the Napoleonic Wars, 40 years before, and systems in the army had not changed since then. Nightingale persuaded the War Office to allow her to go with 38 nurses to one of the worst of the military hospitals, that at Scutari in Turkey. There she found appalling scenes.
Ten times more soldiers were dying from illnesses such as typhus, cholera and dysentery than from battle wounds. Conditions at the temporary barracks hospital were fatal to the patients because of overcrowding, the hospital's defective sewers and lack of ventilation. Nightingale began the process of cleaning up the filthy conditions in which the soldiers lay, providing fresh beds, bed clothes, clothing and bandages, improving ventilation and nutrition, and paying attention to the patients. All of this improved things greatly, but the real problem was that the barracks had been built on top of an enormous cesspit. A sanitary commission, sent out by the British government to Scutari in March 1855, almost six months after Nightingale had arrived, flushed out the sewers and death rates were sharply reduced.
Nightingale continued believing the high mortality was due to poor nutrition, lack of cleanliness and shortages of supplies like bedclothes and bandages. It was not until after she returned to Britain and began collecting evidence for the Royal Commission on the Health of the Army that she came to believe that most of the soldiers at the hospital were killed by poor sanitary conditions. This realisation made her a staunch proponent of improved sanitation in hospitals.
HER TIME IN the Crimea made her an enormous celebrity, bigger than anything we can imagine today. She resolved to use her notoriety as a lever to extract health reform measures from government. Her contacts were unparallelled, ranging from Queen Victoria to various prime ministers and secretaries for war. She effectively authored two immensely influential Royal Commission reports, one on the health of the British army at home, the other on the health of the army in India. Her Notes on Hospitals had far-reaching effects on the design of hospitals. She also had serious input into improvements in workhouse infirmaries and in midwifery services. She is a model of the effective reformer, using the political structures of her time to achieve genuine change.
Extraordinarily, all of this was accomplished from her bed, as she contracted what is now thought to have been chronic brucellosis in the Crimea in 1855, and remained more or less bedridden until her death in 1910. Complaints about her personality, ranging from coldness to her family to bullying to impatience and bad temper, have to be judged in the context of ongoing illness and quite severe pain. Her friend Benjamin Jowett, professor of Greek at Balliol College, Oxford, said of her in the 1860s: "Her mind appears to be as clear and strong as ever. The illness affects her character more than her intellect."
Mark Bostridge's new and comprehensive biography deals fairly with this complex and extraordinary woman, who wrote 14,000 letters in her lifetime, some of them hilarious. Her wit was as much a part of her as her administrative and networking genius, her religious conviction and her incapacity to suffer fools gladly. Bostridge gives us a well-rounded portrait of a woman who has been seen at various times as national heroine, ministering angel, feminist icon, precursor of the National Health Service, closet lesbian and monstrous bully. He could have used many more illustrations, as he has a lot to say about the iconography of Nightingale, and it is frustrating to read accounts of various representations of her only to find they are not reproduced. But this is an important contribution to scholarship on a woman who was a mixture of Elizabeth Bennett, Queen Victoria and Aneurin Bevan.
Catriona Crowe is a senior archivist in the National Archives of Ireland, and a committee member of the Women's History Association of Ireland