Geoff. Muirden

A contradiction lies at the heart of Florence Nightingale’s personality: on the one hand, we have the popular vision of the tender "lady of the lamp", who softened fevered brows of weary, suffering and dying soldiers and who tended their needs at a time when the British Army cared little for their survival; yet, on the other hand, there is a less popular but nevertheless realistic image of a "battleaxe": a stern, mistress determined with a kind of arrogant and merciless determination to force others to do her will: a ruthless organizer and taskmistress that would brook no opposition. It is a legend that lives on in hospitals today: the tradition of care for the sick, accompanied by an iron discipline. One can have sympathy for the goals of the matron, who is dealing with cases of life and death that require immediate and competent attention, yet at the same time sympathise with the rigours of subordinates working under what can be a draconian regime. Whenever "excellence" is aimed at in any area, it seems to require some kind of iron rule as the price to pay for achieving it.

The irony is that both contradictory sides of her personality are true, which makes her a fascinating and complex character to study. Controversy still swirls around her skirts, and will continue to do so. It is now more than 150 years since Florence Nightingale started her nursing career and the Florence Nightingale Project is organizing publication of all the correspondence of Nightingale in 16 volumes. www.sociology.uoguelph.ca/fnightingale

This is a daunting task, as Florence was a voluminous correspondent and, once it is completed, will not only make the task of assessing her more complicated, but it will also raise the danger that, in view of the great bulk of material, historians will be selective in their portrait, possibly choosing only whatever suits their thesis and ignoring contradictory material. This is always a problem for historians, and cannot be totally avoided, since more material exists than can be reasonably accessed. For those who want to see a museum connected to Florence Nightingale, there is the Florence Nightingale Museum at 2 Lambeth Palace Road, London, SE1 7EW  www.florence-nightingale.co.uk just over the river from the Houses of Parliament. Ironically, this is a site that Florence Nightingale condemned.

The problem with the legend of the "Lady of the Lamp" is, not that there is no truth to it, but it is part of a much greater reality. Florence Nightingale did indeed stroke fevered brows and smooth pillows, and earn the hearts of many patients, but this was itself only a small part of a more complicated routine of dealing with people and circumstances. In order to survive a tough environment like Scutari, one had to have an iron will, and a strong discipline.

Florence was no "shrinking violet": she had these qualities in spades and this determination persisted long after she left Scutari, making herculean efforts to reform the organizations that had made the charnelhouse of Scutari possible. Nevertheless, the gentle and romantic myth of the saintly "lady of the lamp" served a "politically correct" purpose of the time, by promoting a vision of male soldiers, ably and lovingly propped up by selfless female nurses to support the war effort. To present Florence as she was - a staunch and vitriolic critic of the system, moving heaven and earth to bring about political reform, stretching into the levers of power in British government and exposing the corruption and incompetence of the British army, was not a "user friendly" image, popularly encouraged. Indeed, since Florence, after her return from Scutari, showed no inclination to socialise or receive popular acclaim, this saintly model was not tested by meeting the real Nightingale, and thus it flourished in ignorance. (Webb, pp.12-13) Even today, the legend of the "lady of the lamp" still persists in those who have not studied her career closely. For those who have, the impression gained is not quite so saintly. A woman, perhaps, of saintly intentions, yet a hard taskmistress.

One of her most ardent critics, Lytton Strachey, who wrote some of the most damaging comments about her, devotes considerable attention to her almost maniacal drive to accomplish reform. She emphasized human effort in getting things done, which she appeared to believe was part of the Divine plan for her and humanity at large. Lytton Strachey waxes sarcastic about this. He is cynical of her religious devotion to God. He speaks of "a demon possessing her" (Strachey, p. 119). Speaking of Florence’s mother, who moaned that "we have hatched a wild swan", he comments that "it was not a swan they had hatched; it was an eagle," (and an eagle is a bird of prey.) (Strachey, p. 124)

Later, speaking of her efforts at reform after she returned from the Crimea, where she forced herself to work, he comments: "Madness? Mad- possessed- perhaps she was. A demoniac frenzy had settled upon her. As she lay upon her sofa, gasping, she devoured blue-books, dictated letters, and, in the intervals of her palpitations, cracked her febrile jokes." (Strachey, p. 146) Nightingale’s incredible "workaholism", which may have stemmed from a theology of "salvation by works", is further demonstrated by her efforts at creating and fostering Army reform and health matters: "Her desire for work could now scarcely be distinguished from mania. At one moment, she was writing a "last letter" to Sidney Herbert; at the next she was offering to go out to India to nurse the sufferers in the Mutiny" (Strachey, p. 158). Her philosophy seemed to be "the world is out of joint, oh cursed spite/ that ever I was born to set it right!" And she tried to set it right. She believed that only she could provide and drive and leadership to bring about reform and perhaps she was right, as few others could match her dedication and "workaholism". Strachey’s parody of Nightingale’s religious views takes the form of an observation that: "Miss Nightingale has got the Almighty too into her clutches, and that, if He is not careful, she will kill Him with overwork" (Strachey, p. 171) He is saying that she demanded God measure up to her requirements and, if not, He must be drilled into submission!

Strachey’s claims of her "demon", though a parody, have this much truth in them: that a case could be made that her massive drive for reform and its consequent overwork, had an adverse effect on her health, and cast a great burden on those who worked with her. Indeed, her drive to demand all-out labour from Sidney Herbert in reform of the War Office (which in the end failed) seems to have led to his premature demise. It may have led to the death of one of her assistants, Arthur Clough and to the action of Aunt Mai, her female aide, in leaving her. (Stachey, p. 165).

She drives them hard just as she drove herself and could not understand why others would not work with the same dedication and commitment. Her dilemma was shared by others who have a burning desire to achieve a goal, but which demands such efforts that few but Trojan warriors can achieve it.

She accomplished astonishing things by her persistence, but she paid a heavy price in terms of her own stress and strain and the draconian demands levied on her supporters. She evidently put the work above her comfort. She said: "if you think that my living the Robinson Crusoe life that I do is the effect of Stoicism, there never was a greater mistake. I cannot live to work unless I give up all that makes life pleasant. I never said it was "best for me". All I said was, it was best for the work - or rather, that it is the only way in which the work can be done, with the present habits of people of my class." (Webb, p. 165) She was "crucifying" herself for the work.

One can sympathise with her fellow workers: it is a hard thing to work with a female drill-sergeant, who will not brook opposition to her plans, and has no time to "sniff the daisies" while there was work to be done. There is a kind of analogy here with the nurse in a hospital who has to fit into with the demands of a matron, who has a multitude of labours to perform and needs iron discipline to do it. Such a person puts a premium on competency and obedience to orders to get the job done, as the most practical way to do things, but can make life a misery for those more sentimentally inclined, and less driven to perform, at least in that way. Paradoxically, one can sympathise with her aims while deploring some of her means.

However, an analysis carried out in a more modern setting show nurses may "toughen up" to cope. Pines and Aronson examined nurses dealing with terminally ill patients.

The nurses started out with idealistic expectations of helping the patients. They gave the patients their deepest feelings, but received little in return. In order to cope, they developed calloused emotions to prevent the drain on their feelings, feeling guilty about the changes in themselves. (Career Burnout: Causes and Cures by Ayala Pines and Elliot Aronson. NY, Free Press, 1988, p. 3, mentioned in Jaeger, Barrie. Making Work Work for the Highly Sensitive Person. New York, McGraw-Hill, 2004, pp. 87-88) They could develop a kind of "plastic smile", looking crisp, cheerful and efficient, while feeling desolate inside. Maybe some nursing "idealism" has to go in the interests of survival.

Strachey, despite his cynicism, gave credit to Nightingale for her contribution, but his portrait was incomplete. Strachey’s version is a condensed version of a much longer, more complex, and fairer, view of Florence Nightingale. Webb,Val. Florence Nightingale; The Making of a Radical Theologian. St Louis, Mo, Chalice Press,2002, p.

Val Webb’s portrait of Nightingale is more sympathetic, especially in terms of religious views, which she sees as the central motivation for Florence, even more than a passion for nursing. Webb’s personification of Florence as a "feminist" may be out of place, in that she does not meet the criteria of many modern feminists. She habitually used the male pronoun to speak in terms of humanity ("he", "him" etc.), downplayed female suffrage as less immediate than some other concerns (Webb, pp. 112-113) and was just as capable of lambasting women as well as men in her diatribes. More so, since her wrath fell more often on women than men (Ever Yours, Florence Nightingale; Selected Letters , by Martha Vicinus and Bea Nergaard. London, Virago, 1989, p. 164), even though she sympathised with them in her book, "Cassandra" and she bitterly claimed that "my doctrines have taken no hold among women. Not one of my Crimean following learnt anything from me - or gave herself for one moment after she came home to carry out the lessons of that war or of those hospitals." (Ever Yours, p. 230) In this, she probably did less than justice to her fellow-workers, but she was demanding that they take the same obsessive interest as herself, a gargantuan drive that benefitted the world in general but was so hard on herself and others. The irony is that, the year before she made that statement, in 1860, the Nightingale Training School for Nurses opened at St. Thomas’s Hospital in London, where there is a museum in her honour. Even today, most nurses in the world are women, who take the Nightingale Pledge and continue in her tradition.

However, it should be noticed that the "Nightingale Pledge" that many nurses take, was not invented by Florence herself, but by Lystra Gretter, an instructor in nursing at the old Harper Hospital in Detroit, Michigan, and was first used in 1893. It is an adaptation of the Hippocratic Oath taken by physicians (www.countryjoe.com/ nightingale/pledge.htm -also see A Short History of Nursing, by Lavinia Dock and Isabel Stewart. Appendix IV)

The merit of Webb’s presentation is a detailed presentation of the thesis that Florence was a "radical theologian", whose religion was a criticism of existing orthodox religion, but embodied a spirit of genuine devotion to God. Towards the end of her life, Florence summed up her philosophy of religion: "You say that "mystical or spiritual religion is not enough for most people without outward form." And I say I can never remember a time when it was not a question of my life (italics mine). Not so much for myself but for others. For myself, the mystical or spiritual religion as laid down by John’s Gospel, however imperfectly I have lived up to it, was and is, enough. But the two thoughts which God has given me all my life have been...First, to infuse the mystical religion into the forms of others (always thinking they would show it forth much better than I), especially among women to make them the "handmaids of the Lord". Secondly, to give them an organization for their activity in which they could be trained to be the "handmaids of the Lord".. When, very many years ago, I planned a future, my one idea was not organizing a hospital but organizing a religion." (Webb, p. 298) (italics mine)

This drive to organize a religion did not motivate her to create a new religion, with herself as high priestess, such as Mary Baker Eddy created Christian Science. It took the form of an inward conviction rather than an organized or official church. Indeed, she was against official church bodies. This drive to build into her life and those of others, a mystical presence and, for women, to make them "the handmaids of the Lord" is the motivation for Florence’s actions and goes beyond the "lady with the lamp." If indeed she carried a lamp, she wanted a sacred lamp that would guide people to God. She wanted life to become, not belief in a Creed but in an indwelling presence of God, and this, she believed, would come about by challenging our ideas about "fitting in" to the ordinary state of life into which we were born. She believed that "we MUST ALTER the "state of life", (NOT conform to it) into which we are born, in order to bring about a "kingdom of heaven" (Webb, pp. 288-289). A conviction of this kind help explains the driving force of her labours. She struggled to believe "in the plan of Almighty Perfection to make us all perfect." (p.289)Her religious convictions impelled her to serve the poor and cater to their needs. And, as for nursing, the character of the nurse was to be judged against Christ, who "was the author of our profession. We honour Christ when we are good nurses." (Webb, p. 293) She believed that, as well as Christ being Saviour, God’s work required other "saviours" including herself, to advance society (Webb, p. 107)

Born of a well-to-do family, if she had had a different personality she might have obligingly fitted into into the mould her parents had for her, in which Victorian young ladies sat about looking decorative, mastering pursuits like playing the piano, practising needlework, marrying a handsome man and raising a family. Other women in her era were content (or resigned) to this, to "fit in" with Victorian era requirements. But Florence, named after the city of that name in Italy, was of sterner stuff. She was born into a Unitarian family and, although she explored different religious convictions later, retained a faith in God and believed that He had called her for a higher purpose, in 1837, when she was 17. (Hugh Small. Florence Nightingale, p. [10]She was willing to obey the Divine Call, but it was not at first clear what He wanted her to do. Seven years later, she decided He wanted her to work in hospitals (Small, p. [10].

Her family felt perturbed when Florence showed an inclination to be a nurse, because at that time, nursing was considered a low-status and disreputable occupation, and nurses in general had a reputation for "loose living", drunkeness, and poor training in medical skill. Despite this, Florence Nightingale felt "driven" to a nursing career. On the outside, she appeared to conform to the expectations of high society by carrying on "cultivated pursuits" which would be appropriate to a "gentlewoman" of those times, yet secretly she explored reports of medical commissions, sanitations, hospitals and homes. She eventually gave her mother and sister the slip and went off to work at the Kaiserwerth institution, where she worked for three months.

She was offered marriage to her courtier, Richard Monkton Milnes and, despite an internal struggle (for she really found him attractive), she nevertheless decided not to marry him. If she had married him, and turned her energies into the domestic scene, perhaps the history of the world would have been different, but she made a "leap in the dark" and rejected him to follow a future of her own determination. She wanted to "march to the beat of a different drummer" and became the superintendent of a nursing home in Harley Street. But much bigger and more important things were ahead for her.

The Crimean War broke out in 1854, and the slaughters and terrible conditions of the military hospital at Scutari (the British name for Uskudar, Turkey) Small, p. [21] began to be known in England. Florence’s inclinations and prior training fitted her for the task but, as well, she had the backing of an influential friend, Sidney Herbert, at the War Office and in the British Cabinet, which was to prove decisive as she pressed for medical reforms. Thirty eight nurses were sent, under the backing of Florence, to Constantinople (now Istanbul). They arrived at Scutari on November 4th, 1854 (Strachey, Lytton. Eminent Victorians. London, Chatto & Windus, 1918, p. 127) The hospital, already overcrowded, was swelled with the casualties of the battle of Balaclava, ten days before, and the battle of Inkerman, which followed the next day.

The wounded soldiers faced desperate conditions - a shortage of doctors, few beds, blankets and little clothing, inadequate food and medical supplies. The death rate was high.

It might have been expected that the overworked and overcrowded male staff who attended the wounded and dying would have welcomed the influx of female nurses yet they were, at first, regarded with suspicion and hostility. One reason was that Nightingale did not hesitate to condemn policies of the doctors and staff if she felt they were wrong, which did not add to her popularity. It says much for the courage and fortitude of Florence Nightingale and her nurses that they did not turn back at the magnitude of the task, but did all they could to assist and did not shirk their duty. Whereas government provided little assistance, Florence Nightingale received donations from Macdonald, of The Times newspaper, to pay for supplies.

Sidney Herbert, who had encouraged Nightingale to come over, had chosen her because of her strict authoritarian temperament and ability to impose obedience over her staff. (Small, p. [18]) She may have been a "terror" to work for, and one could pity her staff, but there is no questioning her dedication to the task, and no gainsaying the fact that she, at times, ploughed her own money as well as that of others into reforms such as the installation of boilers in which to wash clothes, and cooking utensils and "eating irons" supplied. (Strachey, pp. 134-5)

Many of the soldiers adored Florence as a "ministering angel", and a side of her that was gentle and kind showed itself in caring for the sick, almost a maternal side in caring for the helpless, yet there was also another side of grim determination, of stern dedication to duty, by strict discipline, by bending others to her iron will in which she became a female drill sergeant, She Who Must be Obeyed.

She was not subservient to authority: when she felt that anyone, no matter how high his or her rank, was acting unjustly or shirked their duty, she was merciless in her criticism. (Strachey, p. 139) She even bullied Sidney Herbert, who fell out of favour in not having carried out her wishes in the manner demanded. But neither he, nor his successor in the War Office, Lord Panmure, despite rebukes from Nightingale, seriously tried (or dared?) to stop the juggernaut, Florence Nightingale. Public opinion backed Nightingale, and Queen Victoria and Prince Albert asked to see her and gave her royal approval. (Strachey, p. 140)

The "Aegean Stables" at Scutari had been cleansed, not perfectly, but so well that, after six months work there was a distinct improvement. But while the medical needs of the men had improved, Nightingale decided to add to it reading rooms and recreation rooms, acting as if the men were valuable human beings, a viewpoint not generally agreed upon by the army.

As if this were not enough, Florence inspected hospitals in the Crimea, travelling in difficult and hazardous conditions to reach them. She stayed on in the Crimea until every soldier had left. (Strachey, p. 143) She returned to England in a blaze of glory. But the story did not end there. She stayed in England for more than half a century after the Crimean War, and despite being an invalid for most of that time, generated an incredible amount of work.

Florence is generally remembered, first for her work at Scutari and secondly, for her work in promoting nursing as a profession. However, the book by historical revisionist Hugh Small questions the image of Nightingale as the dedicated angel of Scutari. He does not doubt her dedication to the task, but he maintains that, after she returned to England, she became convinced that she had followed the wrong policy and that the highest casualty rate in the Crimea was Florence Nightingale’s own base hospital at Scutari. "Nightingale had not been running a hospital. She had been running a death camp" (Small, Hugh. Florence Nightingale, Avenging Angel. London, Constable, 1998, p. 88)

Nightingale at first believed that the casualty rate was high because the victims were "half dead", and because of factors such as bad food. (p.95) She had agreed with the assessment which commissioners John McNeill and Colonel Tulloch had tried to push through Parliament, blaming the casualties on incompetence on the part of the officers and the failure to pass on food supplies close to hand. (Small, p. 56) The Board of Generals did a complete whitewash job on the accusations, finding the army officers innocent and passing the buck to civilians in the Treasury (p. 66) To add insult to injury, the four army officers blamed were promoted. (p. 68) It was not the first time, nor the last, that organizational power suppressed reform and maintained those in control.

The rejection of the McNeill & Tulloch report shocked Nightingale, but she was to be far more shocked by the suggestion, by Col. Tulloch’s friend, Dr William Farr, the statistician, that analysis of the deaths in the Crimea showed the fatality rate had mostly been due not to inadequate food, overwork or lack of shelter, but to bad hygiene. (p.88) Statistical analysis showed that Dr Sutherland’s Sanitary Commission had great success in reducing the death rate when they cleaned up the hospitals in the Crimea. (p. 92)

Small admits that absolute proof of Farr’s thesis was lacking (p.95) nevertheless it convinced Nightingale, and she found it devastating, because, if true, it meant that her policy in Scutari had been wrong, and because she had paid little attention to hygiene, she had let many die needlessly. In fact, mortality at her Scutari hospital was higher than that elsewhere. Farr’s statistical tables did not back Nightingale’s belief that patients sent there were worse than others. In fact, patients with hardships no worse than those elsewhere still fared worse in Nightingale’s hospital. (p. 93,109) If statistical analyses had been done at the time of the Crimean War, these factors may have been brought out, but they were not.

Scutari hospital was a "hell hole", built over sewers with poisonous vapours wafting from them, the rooms dirty, vermin-infected, and overcrowded. There was little ventilation and the rooms had a massive stench. Yet the connection between this and mortality seemed not to have been understood at the time.

Small suggests these revelations were traumatic to Nightingale, who felt traumatized by following nursing policies that ignored the key cause of mortality and so needlessly wasted lives. Despite the fact that this would serve to discredit her, she pushed for a government investigation but the government was understandably reluctant to expose its own role in disastrous policies. Cross-examination of Sir John Hall, Principal Medical Officer at Scutari and his subordinate, Dr Mouat, avoided the subject of whether they approved the sanitation in hospital buildings and failed to supply any documentary proof of having objected to it. They managed to squirm out of any responsibility and Sidney Herbert’s government survived unscathed. (p. 102-3)The cover-up, bigger than "Watergate", succeeded.

Most politicians, faced with a scandal, deny it , attempt to sweep it under the carpet, scapegoat or crush those who want to expose it. It is to the credit of Nightingale that she was willing to reveal the truth but political opposition to its release led to a compromise: Nightingale wrote a confidential report, claiming bad hygiene as the primary cause of death in Scutari, and circulating it to individuals on the understanding it would not be publicly released. But the trauma of knowing she was responsible for policies that had cost the lives of thousands of patients, according to Small, explains why she cut down involvement in nursing and kept her "guilty secret". However, she worked henceforth to compensate for her miscalculation.

Centuries ago, Socrates had closely questioned those who were supposed experts, and found they were not expert at all. The same might be said for Nightingale, who entered Scutari, chosen as an expert by Herbert’s government, yet who proved to be not an expert on the apparent major factor of mortality: hygiene, a factor she later emphasized for the rest of her long life.

Although she will always be remembered sentimentally as "the lady with the lamp", nevertheless her years in Scutari only occupied two out of her ninety years on earth. She actually accomplished much more than that, after her return to England.

Perhaps the full story of her accomplishments will never be known, since much of what she did was not made public. She worked through others to do most of her work. She did much for army reform. She forced the Government to establish a Royal Commission on the Health of the Army at home, and then to act on it. She showed a great interest in India and in 1859 instigated a Royal Commission on the Sanitary State of the Army in India. She ended up with a "global outreach" to many foreign governments and countries. In 1863, she persuaded the Colonial Office to let her investigate the effect of European schools on native populations, collecting data from Australia, Ceylon, Natal, West Africa and British North America. She assisted on finalizing the Geneva Convention and Henri Dunant, publicly stated that: "though I am known as the founder of the Red Cross and the originator of the Convention of Geneva, it is to an Englishwoman that all the honour of that convention is due. What inspired me to go to Italy during the war of 1859 was the work of Miss Florence Nightingale in the Crimea." (ref. Webb, p. 270)

Although in these "politically correct" days it has been fashionable to highlight the work of a nursing rival, the black nurse, Mary Seagove, who did much good work as a nurse in the Crimea, and also establish a hotel there to assist the soldiers, overall it can be said that Florence Nightingale’s influence worldwide has been much greater.

In assessing Florence’s personality, and the drive that made her what she was, she may have been the kind of personality now coming to be known by some psychologists, as the "Highly Sensitive Person" (H.S.P.) Highlighted by Elaine N. Aron in her book, The Highly Sensitive Person. New York, Broadway Books, 1997).

This type of personality was a minority group in society in Victorian society and remains a minority group now. Although Florence had problems fitting into the mould of Victorian society, if she was an H.S.P. by nature, she may still have had many problems in many societies nowadays. If this is so, Val Webb’s emphasis on her problem accepting Victorian mores may be only part of the story.

An H.S.P.is a person with a more strongly developed sensitivity than normal or average, and become of this extra sensitivity can feel things more deeply and understand things at a deeper, more intense level than ordinary people. This intensity can lead to a state of "overwhelm" because of overstimulation.

H.S.Ps, being different than the ordinary person, are frequently misunderstood and unappreciated, being condemned as "too sensitive" or even "neurotic". One writer calls it a neurotic trait (Louis B.Bisch, Be Glad You’re Neurotic. New York, McGraw Hill, 1946) but sees it as a sign that its owner has superior actual or potential abilities. More recent interpretations see it as a minority personality trait that is frequently misunderstood.

Those who have such a tendency cannot "fit in" to the ordinary workplace without a lot of adjustment. Because of this, they may feel "odd" or "strange" compared to others. They are not tough or outgoing like most ordinary people. They "march to the beat of a different drummer" and need a job that fits their personality. They may spend years before they find their true vocation in which they can feel fulfilled. Conventional jobs and conventional families, mostly run by non-HSPs, cannot satisfy them. They are frequently highly moral individuals, who need a cause, or even a succession of causes to devote their lives to. They are often very spiritually motivated, although it may not be in conventional religion.

It is possible that Florence Nightingale was an H.S.P.and that this may help explain some of her personality and developments. Her family, especially her mother and sister, could not understand why she could not "fit in" to family expectations. She never could, being of an inherently different nature. She agonized about this: "why, oh my God cannot I be satisfied with the life that satisfies so many people?" (Webb, p.xv, Preface) She proved intellectually very capable - her father taught her Greek and Latin and mathematics, while she was very quick at learning foreign languages. (Webb,p. 9) Her Greek was good enough to assist the Oxford don, Jowett, later in life, to translate Plato.

Yet this did not satisfy her yearning for a life goal, which her family could not understand. Her objections to "frittering time away on useless trifles" (Webb, p. 25) was a useless diversion from her real purpose in life. But what was that call? In 1837, she received what she believed her first call from God but alas, it was not clear what He wanted. As has happened with other people, revelation of God’s purpose was progressive.

In 1849, when it seemed she was "steered" into the nursing arena, she received a second call from God after she rejected an offer of marriage from Richard Monckton Milne. She found it hard to escape from family problems. When she nursed her soldiers, she reflected bitterly that she had expended on them more motherly love in a week than her mother had expended on her in 37 years. (Webb, p. 162) But perhaps it is true, that she took on "mothering the whole world" (Webb, p. 165) since she ended up with a "global outreach" of reform in countries around the world.

In 1865, she received another call from God and became devoted to poor law reform and assisting the poor. H.S.Ps feel impelled to grow and expand through life, and this was true of Florence Nightingale.

Perhaps she was also impelled by another personality factor: she has been determined as having the personality type of INTJ (Introversion, Intuition, Thinking and Judging) on the Myer-Briggs Scale. This, the most rare of the personality types, shows an intense preoccupation with an inner life of impressions and ideas, developed best in a life of solitary endeavour and single-minded devotion to ideals. Although her retirement to the life of an invalid after Scutari may have been partly the result of illness, it could also have been a means to achieve the solitary and dedicated devotion to a life cause, without interruption and without family or "office politics." (Webb, p. 159) A "loner" by nature, it suited her temperament.

Florence Nightingale had an extraordinarly complex life, one that is difficult to sum up. Although she was more than just the "lady with the lamp" and contributed to more than just nursing, having assisted in sanitation, poor law reform, and many issues of social reform, to mention just a few of her concerns, nevertheless her role as "radical theologian" may be less secure.

She founded no "Church of Florence Nightingale", even though she built Christian precepts into her work. Her theology cannot yet be fully assessed, until all her writings are published, yet there may be some merit in the objections of Jowett and others that she was unsystematic in this.

One fatal flaw in her approach could be that it is an attempt at "salvation by works" in which, no matter how hard anyone works, they can never do enough, a philosophy leading to physical and mental exhaustion. Judging by her writings and attitudes, she seems to have had some of this in herself.

Part of her theology seemed to be that humanity had to learn from bad experiences what was God’s Law concerning health, and to apply it. It is true that, in theory, that sounds like a good idea. Yet, the history of medicine shows many instances in which vital medical findings have been ignored or even vilified. These examples tend to justify the axiom that: "the only thing men learn from history is that they do not learn from history."

One example of this neglect is that information on the cure of scurvy was available long before it was acted on. As early as 1593, Sir Richard Hawkins spelled out oranges and lemons as cures for scurvy. In 1601, Captain James Lancaster prevented scurvy on board his ships, using lemon juice.

James Woodall, the "father of naval hygiene", published The Surgeon’s Mate in 1636 stating that scurvy could be prevented by fresh vegetables and the use of lemons and oranges.

This was 111 years before Lind’s famous experiment on the Salisbury in 1747 and 159 years before lemon juice was made requisite in the British Navy. Louis H. Roddis, writing in A Short History of Nautical Medicine , says: "it is estimated that 5,000 lives a year were needlessly lost from scurvy during this period: a total of nearly 800,000. In the 200 years from 1600 to 1800 nearly 1,000,000 men died of an easily preventable disease. There are in the whole of human history few more notable examples of officially indifference and stupidity producing such disastrous consequence to human life." http://www.riparia.org/scurvy_hx.htm

But that was not the only example of medical stupidity. In the 19th century, Ignaz Philipp Semmelweis was a Hungarian doctor in Vienna, who noticed that doctors would go straight from treating cadavers to dealing with patients, without washing their hands. He wrote a book to show that patient mortality would drop if doctors only washed their hands, and it was rejected by the medical profession.

In 1865 he had a mental breakdown and was sent to a mental asylum, where he died. That same year Joseph Lister began spraying a carbolic acid solution during surgery that lowered mortality rates. He conceded that: "without Semmelweis, my achievements would be nothing", a posthumous tribute that availed Semmelweis nothing.

Closer to home, Florence Nightingale had an example of medical incompetence in London. Cholera epidemics hit London during the 19th century, leaving tens of thousands dead. However, a Dr John Snow noticed that a pump in Broad Street used by many people was contaminated by sewage-laden water, which he was convinced was a cause of cholera. He took a sample of polluted water to the Board of Guardians of St Jame’s Parish, who agreed to remove the pump handle, whereupon the death rate from cholera fell.

However, the marketers of the water, the Vauxhall Water Company and the Board of Health, rejected his claim that the contaminated waters contributed to cholera. "After careful enquiry", the report ended, "we see no reason to adopt this belief."

A magazine, The Builder reported later that "even in Broad Street, it would appear that little has been done...in St Anne’s Place and Annes-Court, the open cesspools are still to be seen; in the court, as far as we could learn, no change as been made; so that here, in spite of the late numerous deaths, we have all the materials for fresh epidemic." www.ph.ucla.edu/epi/snow/broadstreet pump.html

They had learned nothing. (Cadbury, Deborah. Seven Wonders of the Industrial World. London, Fourth Estate, 2003, p. 174)

As Cadbury says: "Despite two decades of research and experimentation, Dr John Snow had failed to convince those around him that it was not smell, but water, which was a potential killer. For just over a twenty-year period, he had watched, powerless to save lives, as cholera returned again and again to terrorise the population, leaving over 30,000 dead...Snow died of a stroke, aged only 45. With no one to grieve for him and his seemingly wasted lifetime’s work, all the excitement and wonder at solving the secrets of cholera’s power were buried in careful plans in the debris of his work." (Cadbury, p. 180)

The statistician, Farr, who assisted Nightingale, finally had to admit, long afterwards, that his earlier opposition to Dr Snow had been misguided, and that cholera was water-borne and not the product of miasma. It is not known if this revelation made him as "thunderstruck" as the news conveyed to Nightingale that her work at Scutari had ignored the key role of hygiene and sanitation, which Small claims made Florence "conscience-stricken."

Nevertheless, the case was that "the key evidence had been in place since 1849 but went unrecognized by an establishment blinded by their own beliefs. Now, years after his death, Snow had at last been vindicated. Had he been taken seriously during his lifetime, many thousands of lives might have been saved- included another 5,595 in this latest epidemic." (Cadbury, pp.191-2).

These are some of many examples showing the apparently unlimited capacity of medical "authorities" to ignore or ridicule evidence that could save the lives of thousands. So it would be rash to assume that the medical profession is an alert and active body, faultlessly improving our health and correctly interpreting the evidence with unerring skill. Ignorance or vested interests can delay or quash medical discoveries when they feel like doing so, and regardless of the loss of lives involved.

It is estimated that the builder of the massive sewage systems in London, Joseph Bazalgette, "had almost certainly saved more lives than any other single Victorian." (Cadbury, p. 197) He got public recognition for his work, while Dr Snow was dumped and dishonoured.

It is not clear the extent to which Florence Nightingale knew about these lethal "mistakes" by the medical profession. There seems some disagreement about whether or not she accepted the "germ theory". However, what is less discussed is the claim by some that Pasteur not only plagiarised the "germ theory", but that it is an inferior version of a theory promulgated by Antoine Bechamp, claiming that disease is called by what he called "microzymas." Nightingale is cited as saying: "the specific disease doctrine is the grand refuge of weak, uncultured, unstable minds, such as now rule in the medical profession. There are no specific diseases; there are specific disease conditions." www.sumeria.net/dream/1.html This is taken as evidence that she opposed the germ theory, which now seems to rule in medical circles. If she did oppose the germ theory, it is not impossible, in view of serious mistakes made by the medical profession, in the past, that she may have been right.

She was more than the "lady with the lamp" and not quite a "radical theologian" by trade. She was one of the most remarkable and long-lived reformers that the world has ever seen, and she did all that any human could to make it a better world. Let that be her tribute.

Geoff Muirden

nedrium@netspace.net.au

Wednesday, June 16, 2004 6:15 PM