Florence Nightingale

A Very Brief History

Lynn McDonald

• Publisher: SPCK Publishing
• Year: 2017
• ISBN:
  9780281076468
• Topic: Medicine
• Subtopic: Medicine Biographies

Part One: The History (What do we know?)
This brief historical introduction to Florence Nightingale explores the social, political and religious factors that formed the original context of her life and writings, and considers how those factors affected the way she was initially received. What was her impact on the world at the time and what were the key ideas and values connected with her?Part Two: The Legacy (Why does it matter?)
This second part explores the intellectual and cultural 'afterlife' of Florence Nightingale, and considers the ways in which her impact has lasted and been developed in different contexts by later generations.Why is she still considered important today? In what ways is her legacy contested or resisted? And what aspects of her legacy are likely to continue to influence the world in the future? The book has a brief chronology at the front plus a list of further reading at the back.

Part 1

THE HISTORY

1

Nightingale and the nineteenth century

Florence Nightingale (1820–1910) is perhaps still best known as the doyenne of the nursing profession. What is less familiar to most, however, is her contribution to the great ideas and causes of the nineteenth century. Nightingale became famous for her work during the Crimean War (1854–6), when she led the first team of British women to nurse in war. Then, during the rest of the century, she used the reputation she gained there to promote a series of great reforms. The establishment of professional nursing was only one of her achievements, and was always pursued in the context of broader public health concerns. She is still recognized for her contribution to hospital reform, from design to administration and the care of hospital employees. Her statistical innovations, in analysis and the presentation of data, however, also had an enormous impact: where would our annual financial reports be without the pie and bar charts she promoted?

Early life

Nightingale was born into a family of wealth and privilege – respectable, but not ‘old money’. Her father, William E. Nightingale, had inherited a fortune, made from lead mining and smelting in Derbyshire, from a relation known as ‘mad Uncle Peter’, who would not leave his money to a closer female relative. W. E. Nightingale received a gentleman’s education, in classics, at Trinity College, Cambridge. He owned two fine country houses, Lea Hurst in Derbyshire and Embley Park in Hampshire. He ran for Parliament once, just after the Reform Act of 1832 was passed and rotten and pocket boroughs were abolished. He was unwilling to bribe voters, however, and lost. Nightingale wished that he would take on such duties as chairing a hospital board, but he never did.

Nightingale’s mother, Frances, was the daughter of a radical MP, William Smith, who had worked with William Wilberforce in the anti-slavery movement (Smith also supported the vote for Jews, Catholics and dissenters). Florence’s parents regularly entertained MPs at Embley, and she was thus exposed to progressive ideas from her childhood. There were other progressive relatives too: Samuel Smith, a double uncle – brother of Frances Nightingale, he was married to the sister of William E. Nightingale – was an official in Parliament. Aunt Julia Smith was an abolitionist, while cousin Barbara Bodichon was a leading suffragist and promoter of women’s employment. A Bonham Carter cousin was a Liberal MP.

Church and faith

Although there were Unitarians among her forebears, Nightingale was baptized in the Church of England and remained in it for life (the family attended the local parish church in Hampshire, a Methodist chapel when in Derbyshire). While she disliked the social conservatism of the established Church, much of its doctrine and its exclusion of women from serious roles, she had nothing good to say of Unitarianism. Roman Catholicism had more appeal, for it at least permitted women serious roles as nuns, but – unlike close friends such as Henry (later Cardinal) Manning, Elizabeth Herbert and Angelique Lucille Pringle, a Nightingale nurse, later matron of the Edinburgh Royal Infirmary and then St Thomas’s Hospital – Nightingale was never tempted to convert. Indeed, as the Roman Catholic Church, under Pius IX, whom Nightingale met in Rome, became more conservative, she became more critical of it. She ridiculed, at least in private, Pius’ declaration of the dogma of infallibility, saying: ‘The pope is infallible because he says so. And we are to believe it because he is infallible who says so.’ 1

Despite her Protestant faith, Nightingale did not accept the conventional doctrine of eternal hellfire, which both Protestants and Roman Catholics applied to infants who died unbaptized. Good Friday was the most important day of the year, she held, and Christ’s sacrifice – as a voluntary act – was sufficient for all. She thought that the portrayal of God as judge with weighing scales demanding that someone pay the penalty was false. God was wise, loving and benevolent. This was a consistent theme in her most philosophical work, Suggestions for Thought.

Nightingale nevertheless continued to read Catholic writers, and would keep in touch with the Sisters of Mercy in Bermondsey, who had nursed with her in the Crimean War. She recounted that its mother superior, Mary Clare Moore, a friend and the person who introduced her to the mystical writers, was the only Catholic she knew who never tried to convert her.

Movements within the Church of England, meanwhile, offered their adherents a range of perspectives and modes of worship. Nightingale knew the leader of the Anglo-Catholic movement, E. B. Pusey. At his request, she attended, as a nurse, the confession of a dying woman. She was a close friend of Benjamin Jowett, priest and master of Balliol College, Oxford, and a leader of the ‘broad church’ movement. Jowett was more heterodox than she, not believing in the survival of individual souls after death, let alone the resurrection of the dead; his notorious essay, ‘On the Interpretation of Scripture’, called for the Bible to be read and criticized like any other book.

Nightingale gave discreet support to such clerics when they came under attack for heresy; one such was Bishop John Colenso, although she found his theology unattractive. Ernest Renan’s Vie de Jesus she read carefully and critically, although he had done nothing, she said, to ‘show us the way’.2 While a fervent believer in freedom of expression, she wondered about the consistency of ordained priests who made such heterodox statements despite signing the Church of England’s Thirty-nine Articles. Jowett himself signed the Thirty-nine Articles twice, the second time to make peace after the outcry over his essay.

It is not often realized that Nightingale made an explicit commitment to serve Christ, thanks to reading The Corner-stone, by the American Congregational minister and educator Jacob Abbott.3 In its opening chapter, the book states its intention

to explain much of the elementary principles of the gospel of Christ as are necessary to supply the most pressing wants of a human soul hungering and thirsting after righteousness, and this gospel, the Bible assures us, cannot be understood unless the heart is willing to comply with its claims.

It urges the reader who has not yet asked for forgiveness to ‘go to God before you proceed further’. This she did, recalling years later to Maude Verney, an evangelical relative by marriage, the ‘American book which converted me in 1836. Alas! that I should so little have lived up to my conversion.’4 Nightingale also read Abbott’s The Way to Do Good, or the Christian Character Mature,5 just before experiencing, in the form of a voice from God, her own ‘call to service’. She interpreted that call – although the nature of her ‘service’ would change over time – as one to tend the sick and the poor.

Throughout her life, Nightingale would have respect for people of other religions. As a young woman travelling in Egypt, she once visited a mosque, dressed uncomfortably as a Muslim woman, with the intention of seeing how her ‘fellow creatures’ worshipped.6 In an article for the Journal of the National Indian Association, she said that Hindus and Muslims supported their sick, old and infirm ‘much better than we could do it for them’.7

Nightingale’s India work would bring her into touch with Hindus, Muslims and Parsis. Conservative Hindus were a challenge for her – some had married as children and continued to support child marriage. Parsis, by contrast, were more progressive, denouncing child marriage, especially its worst concomitant, ‘enforced widowhood’, which entailed the punishment of girl widows for their husband’s death.

Social and public health reform

At the age of 33, frustrated with her uneventful social life, Nightingale was provided by her father with an annuity enabling her to take up nursing, without the indignity of having to accept a salary. The hospital at which she first worked was not a workhouse, or even a general hospital, either of which she would have preferred, but the Establishment for Gentlewomen during Illness, an institution mainly for impecunious governesses. Its Ladies’ Management Committee notably included Lady Cranworth (wife of the Lord Chancellor), Lady Canning (whose husband was soon to become Viceroy of India) and Elizabeth Herbert (wife of the Secretary at War).

Nightingale’s artistically minded sister, Parthenope, later Lady Verney, was vehemently opposed to Nightingale accepting employment even at such a respectable hospital. She only changed her tune when the Crimean War brought celebrity to her sister’s work. Sir Harry Verney, a Liberal MP, was a keen supporter of Nightingale’s work and served for years as chair of her Fund Council, while Lord Palmerston, the Prime Minister who sent the Sanitary and Supply Commissions to reform the army hospitals and camps in that war, was a neighbour in Hampshire. Such excellent connections as these would help Nightingale in pursuing numerous causes, both when she went to nurse in the Crimean War and in her promotion of ‘sanitary’ reform after it.

The nineteenth century saw much progress on social reform, from the provision of compulsory state schools to the enlargement of the electorate and the granting of the vote to women at the municipal level. Married women were also given property rights and some access to higher education. Nightingale’s interest in social reform focused largely on the relief of poverty; her efforts to bring about the reform of workhouses were truly pioneering, and many of them were turned into real hospitals, with quality care and even nursing schools. She looked to the abolition of the Poor Law itself, setting out the principles for such a fundamental change and arguing in favour of providing asylums for the care of the aged and chronically ill, children and the mentally or physically disabled.

On the rise of trades unions, however, Nightingale sided with business, forecasting that the result would be job losses for workers. She remained a staunch Liberal, looking to the private sector to run the economy, although she wanted the state to provide jobs in times of economic downturn. Similarly, while she sought profound reform of the Poor Law, she never envisaged the extent of state provision for income security or care realized in the ‘welfare state’ of the mid-twentieth century.

The late nineteenth century was a time of great advance in statistics and quantitative analysis in the social sciences, especially in what would become sociology and political science. Before the establishment of academic departments dedicated to such subjects (the London School of Economics was founded only in 1895), statistical societies – the first of which, the Manchester Statistical Society, was instituted in 1833 – held conferences and published their transactions. Nightingale sent seven papers to the congresses of the National Association for the Promotion of Social Science, founded in 1857. She sent short papers on hospital reform to the 1860 congress of the International Statistical Congress in London, and on improved statistics on surgical outcomes to its next congress in Berlin in 1863.

One of Nightingale’s earliest research efforts after finishing her Crimean War work was on mortality and illness in ‘colonial schools and hospitals’ – in other words, among indigenous people in Australia, Ceylon (Sri Lanka), southern Africa and Canada’s Red River Settlement. Her research also took her into the issue of the disappearance of aboriginal peoples. Although the data was woefully inadequate – itself an indication of trouble – enough was available to show that rates of death and sickness were twice what they should be. She was unable, however, to persuade the Colonial Office to continue to monitor results, let alone make concerted improvements. She succeeded in getting public opinion interested – her papers received good coverage – but this did not lead to the serious action she hoped for. Nightingale would thereafter concentrate on India, where she had more influence on improving health and social conditions.

Nightingale typically worked on her research and policy development with a team of experts – doctors, engineers, statisticians and architects – so that the reports, books, articles and briefs produced were of high quality and lasting significance. The core principles of her causes, health promotion and high standards for the nursing profession, with her predilection for starting small and monitoring results, still make sense. Much of her writing is still relevant, even with the vast increase in knowledge in medical science, hospitals, public health and public administration.

British imperialism

The nineteenth century saw a vast expansion in the British Empire, justified by firmly held principles of imperialism. Nightingale was a reluctant, critical imperialist; while she saw the benefits of British rule in spreading western science and medicine, education and infrastructure, she firmly believed that British rule should benefit the people themselves, and was well able to see when it did not.

Nightingale’s critical stance on imperialism can be traced back to her own birth in Florence. A substantial part of what is now Italy was then under Austro-Hungarian rule. During her travels in Europe with her family, Nightingale met exiled Italian independence leaders. Later, on a train trip with family friends, they passed Spielberg Prison, where other independence leaders were kept in harsh conditions. She told her family that she was ‘glad to have seen’ it: ‘Imagine a place ten times more dreary, more dull, more hopeless than you ever imagined it before, and there is Spielberg.’ Nothing, she said, could give them an idea of it: ‘Dante and Milton could not do it, but the House of Austria is a greater than they. Spielberg is a greater creation than the Inferno with all its circles.’ All were ‘inferior to Spielberg as a habitation for the damned’.8 As late as Good Friday 1889, Nightingale recalled to a relative the ho...