Was she nice?

Thomas McKeown

  • Florence Nightingale: Reputation and Power by F.B. Smith
    Croom Helm, 216 pp, £12.95, March 1982, ISBN 0 7099 2314 7
  • Edward Jenner: The Cheltenham Years 1795-1823 by Paul Saunders
    University Press of New England, 469 pp, £15.00, May 1982, ISBN 0 87451 215 8

A reassessment of Florence Nightingale and her achievements requires consideration of her public work, her personal character and the relation between the two, and F.B. Smith has interesting things to say about all of this in his study of the Nightingale Papers and other documents. He recognises her impressive contributions, but not her unique place in the history of ideas related to medicine and public health in the last three centuries. His reading of her character would be more persuasive if she were occasionally given the benefit of a doubt. Was she, for instance, always impelled ‘to fight, to cheat, to bully and to boast’ as well as ‘to save lives’? And is it not the case that without the private character we could not have had the public work?

Florence Nightingale came to nursing at a time when standards of patient care were low and the nurse’s professional commitments not always limited to the side of the bed. Like Mr Cochrane in the London theatre at a later date, she made her profession suitable for young ladies and thus solved two problems, one for the profession and one for the young ladies. The professional problem was to attract recruits whose personal background guaranteed reasonable standards of hygiene and morality. The young ladies’ problem was to find employment at a time when marriage was regarded as the only alternative to an idle spinsterhood and primogeniture left many of them without an income. In practice, not enough ladies offered for training, and it was necessary to take ‘women’ from the respectable lower-middle and working classes, who were stronger than the ‘ladies’ and more willing to do unpleasant tasks.

Miss Nightingale’s contributions to nursing have perhaps been overemphasised in relation to her other interests and Smith puts them into perspective. On the negative side, ‘she neither invented modern nursing behaviour nor even the idea of nursing as a calling’; she had little interest in the care of some of the most neglected patients – for example, children and the mentally ill – and her intervention in midwifery training was disastrous; if she cannot justly be blamed for the low salaries of nurses, she did nothing to raise them; she was lukewarm in her support for the emancipation of women. Indeed, Florence Nightingale in some respects is an unsuitable figure to embody the aims of modern nursing, particularly in the United States, where her teaching that the nurse is subservient to the doctor is thought to be inconsistent with the aspirations of an independent profession. On the positive side, she introduced many sound features into nursing practice: her Notes on Nursing ‘is full of pithy good sense and vivid anecdotes about quiet, food, light and reassurance for patients and percipience in nurses’, and her Notes on Lying-In Institutions ‘provoked interest in the subject and accelerated the improvements in cleansing, rebuilding and antiseptic procedures that were beginning in wards about 1870’. Above all, ‘by bestowing her imprimatur upon secular nursing she gave it standing in Victorian Britain and throughout the world’: before she died her standards had been introduced into Scandinavia, Italy, Russia, the United States and throughout the Empire. ‘Rarely can such a beneficial revolution in the lives of so many people – patients and women – have been wrought on the basis of sheer reputation.’ The nurses trained by her methods made possible the modern hospital, and it takes nothing from her achievement to recognise that she was not alone in the enterprise. After this generous assessment it is something of a non-sequitur – and an indication of Smith’s attitude to his subject – to conclude that ‘Miss Nightingale served the cause of nursing less than it served her.’ It would be unfortunate if fine achievements were to be regarded as diminished to the extent that their creators had benefited from them.

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