Florence Nightingale: Nursing, lifestyle, and her influence on and inter-relationships with women

Rosemary Leadbeater, BA, MA           

Oxford Brookes University, Oxford, UK


This article explores the life of Florence Nightingale in respect of her influence on the people, and especially the women, around her. It critically examines recent historiography and investigates the way in which she correlated nursing with the Victorian ideology of the female as nurturer, while at the same time taking a feminist approach towards the upper class role model she was expected to follow.  It looks at the inconsistencies between her teaching and her own actions during the Crimean War and afterward as well as the means she developed to control those around her.  The article challenges the theory that Nightingale’s guilt about the cause of the high mortality rate in the Crimea was a significant factor in her apparent breakdown and through examination of primary sources, suggests that her illness was instrumental in managing her family difficulties, particularly those concerning her female relatives.

The article concludes that Nightingale’s contrasting approach to nursing as a distinct profession (based on the philosophy of obedience) with her use of a prolonged illness as an effective tool to maintain her independence and control, highlights the paradox of her life.

Keywords: Florence, Nightingale, Crimea, nursing, hospital, Victorian


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Florence Nightingale:  nursing, lifestyle, and her influence on and inter-relationships with women

This essay examines the paradoxical life of Florence Nightingale in relation to her use of power and influence over those close to her; contemporaries, hospital nurses, business associates and her family.   There is an abundance of material to draw on in any research activity on Florence Nightingale, therefore I am focusing on four particular areas - Nightingale’s approach to the identity of women, her philosophy on obedience within the wider context of her management of nurse training, her lifestyle and apparent breakdown and her relationships with her associates, examining in particular her interactions with the women around her. 

According to biographer Colleen A Hobbs, Florence Nightingale began her resistance  to the restrictions attached to her wealth and class in 1837, as a sixteen year old girl. Hobbs quotes Nightingale’s claim that ‘God spoke to me and called me into His service,’[i] as this turning point.  As her interest in hospital work began to fulfill this ‘calling’ she met rigorous resistance from her family, fuelled partly by the nineteenth century reputation of hospitals as institutions of immorality and drunkenness, and partly by the significance the Victorians placed on the concept of the family as the mainstay of a stable society.  F M L Thompson expands on this theory in his work The Rise of Respectable Society, maintaining that intangible and unseen threats caused greater concern than visual social problems.  Issues such as child labor, underground female labor and urban sanitation were, to Victorians ‘more identifiable and therefore more soluble’.[ii]  Any unidentifiable factor perceived to cause a threat to the family’s function of an underpinning role in a stable society was to be feared. Nightingale’s attempt, therefore, to break away from a lifestyle encompassing the stifling confines of the upper class female submissive role, created a rift in her family relationships which will be examined more closely later.

There is a wealth of material to draw on to identify Nightingale’s philosophies.  She wrote feminist literature prolifically, commented extensively on army and hospital reform and known surviving letters written by Nightingale total approximately 12,000 to date.[iii] She wrote her feminist essay, Suggestions for Thought in the early 1850s under the initial title To the Artizans of England, during a difficult period as her sister’s companion (to which her accedence was, she later described, ‘an act of insanity’[iv]). She used Suggestions to comment on the identity of women within the family, complaining that ‘man is born into the world – woman into a family.’([v])

The theme running through Nightingale’s Suggestions makes a powerful case for women’s liberation.  She appeared to have a clear image of the role women should be carving out for themselves.  Again, in Suggestions she claimed; 

‘Times are totally changed since those patriarchal days.  Man (and woman too) has a soul to unfold, a part to play in God’s great world.’[vi] 

This piece of feminist literature was not completed until after her return from the Crimea, yet the feminist threads remain evident throughout the work.

Despite the works of Nightingale written from a feminist perspective, there appears to be no evidence to purport that she invested energy into encouraging women to attempt to enter the medical profession, therefore stepping outside the traditional female sphere she had derided as a young woman.  On the contrary, she actively condemned women such as Elizabeth Blackwell (the first qualified female doctor in the United States) who, in the mid 1850s, at the time when Nightingale was superintendent of a hospital in Harley Street, was joining forces with Elizabeth Garrett in Britain, to campaign, eventually successfully, to break into medicine.  It is interesting to explore why Nightingale deliberately distanced herself from this cause, which was at its most active during a period which produced one of Nightingale’s most prolific outpourings of feminist writing.  However, she wrote of the campaigners at the time, ‘Women have made no improvement – they have only tried to be ‘Men’.[vii] Nightingale’s social class also gave her access to prominent women such as Elizabeth Barrett Browning and influential activist and journalist, Harriet Martineau.  Despite these contacts she was critical of ‘reckless physicking by amateur females.’[viii] There is a contradiction therefore of the image of Nightingale promoting an apparent liberation cause to that of her championing a restricted and clearly defined role for women in healthcare.

One theory why Nightingale distanced herself from the campaign to train women as doctors is that she viewed nursing as an adequate step in itself outside the domestic sphere. However, although she was striving to carve out an identity for nurses, (a success as signified by the shift in public opinion after the Crimean War) the following statement is not indicative of a woman working to raise the status of nursing to a professional level. She wrote in 1856, on her return from the Crimea,

‘Hospital nursing .. must remain to the end of time a very humble as well as a very laborious drudgery.  But, … it is a noble work.[ix] 

Although low morale and a high fatigue level may partly account for this despondent tone, her stance here on the standing of nursing, whilst attaching value to it, does little more and possibly less, for the status of women than the ‘drawing room’ lifestyle she despised. Secondly, she yet correlated nursing closely with the well-trenched Victorian ideal of the female as caregiver and nurturer.  She wrote in Subsidiary Notes, ‘Every woman must at some time or other in her life, become a nurse’[x]  and in Notes on Nursing, [the nurse] should ‘cultivate in things pertaining to health observation and experience in women who are mothers, governesses or nurses.’[xi] 

Nightingale purported that women were deploying their skills to best advantage, therefore, by becoming nurses rather than doctors.  She was not particularly supportive of the Women’s Rights activists of the day and indifferent to women’s suffrage.  In a letter to John McNeill in 1865 she wrote, ‘The more chattering and noise there is about women’s mission the less of efficient women can be found.’[xii] She judged that suffrage was an unobtainable goal in the short term and priorities should be given to other issues, as illustrated in her comment, ‘It will be years before you obtain suffrage for women.  In the meantime there are evils that press more hardly on women.’[xiii]  Her argument against a structured campaign to give women equality with men was based on the hypothesis that women should remain within gendered roles.  Women’s Rights activists, on the other hand, she argued, urged women ‘to do all that men do merely because men do it and without regard to whether it is the best that women can do.’[xiv] She was not prepared to challenge gender stereotyping.  Having established that women’s work outside the home should correlate closely with their domestic role, her lack of interest in equal rights for women centered on her theory that women did not need them. 

Another point can be made on Nightingale’s perception of the role of nurses in the context of doctors.  A comment on nurse training made by Nightingale in 1879 provides an insight into her concept of the nurse as an individual who was obedient and answerable to the doctors. On the definition of obedience she links the necessary compliance of the nurse to that of the soldier. (Nineteenth century soldiers carried a poor reputation of being unfit for other work.)

  ‘To obey means to do what we are told and to do it at once. With the nurse, as with soldiers …whether we think it right or not is not the question.  Prompt obedience is the question.  We are not in control but under control.’[xv]

This statement well illustrates that she expected nurses to act under the command of a higher authority and suggests initially that this higher authority was the doctor.  As discussed later, however, there is a more complex theory behind Nightingale’s philosophy on obedience.

In relation to the Nightingale philosophy, Ann Bradshaw has qualified the term ‘obedience’, in her work The Nurse Apprentice.  Bradshaw expands ‘obedience’ to comprise ‘intelligent obedience using discretion’, based on the knowledge that Nightingale herself stressed intelligent obedience, obedience alone being ‘a very poor thing.’[xvi] She wrote these words in 1861, five years after her return from the Crimea.

F B Smith, in his book, Florence Nightingale: Reputation and Power has commented that Nightingale’s uncorroborated accounts of her troubles cannot be trusted because there is evidence that she sensationalized some circumstances.[xvii] Smith’s assumption may not be infallible but it supports a theory that recordings of other people can be more reliable. I have examined some primary sources relating to correspondence to Nightingale to gain insights into her character which may not be revealed in her writings. The following extract from a letter written in 1887 exposes a different approach to obedience when Nightingale applied it to herself. It was written to her by a soldier serving in the 33rd Duke of Wellington Regiment during the Crimean War and the letter has survived as evidence of another inconsistency in her philosophy.  The soldier, Samuel Atkins, wrote to Nightingale over thirty years after the end of the war, about his experience in Soulare (?) hospital as a patient under her care.  Having been wounded at the Battle of Inkerman he wrote,

‘in right arm and down the ribs I was taken to hospital at Soulare.  After being under doctors treatment for a time he said that the next day he must cut my arm off.  You told me that I had not better have it off.  There was no danger.  They could not take it off without my permission and that my arm would look better in my sleeve than the sleeve would look in my waistcoat pocket.’ 

 He was writing to Nightingale in gratitude and admiration.  Soon after he returned home his arm straightened after picking up and throwing a stone and was, 

 ‘able to therefore take employment and follow work ever since’.[xviii]   

It had taken him over thirty years to contact Nightingale after the war and one can only surmise why he decided to write after the long time lapse.  He may have been in a contemplative mood as he approached the end of his working life or he may have been inspired by publicity such as Kingslake’s romanticized account of the Crimean War, published in the second half of the nineteenth century. The contents of the letter illustrate that Nightingale was not demonstrating obedience in herself in this situation, although there is no record of any subsequent discussions she may have held with the doctor which could have embraced intelligent obedience.   (If she had had more evidence of the success of her non-compliance, it is possible that she may not have applied the obedience rule so forcefully later in her teachings.)

One theory on the inconsistency between her teaching and her own actions during the Crimea is that, as she became the authority on nurse training, writing Notes on Nursing, she raised the significance of obedience, particularly after she returned to the well-entrenched hierarchical structure of Victorian England.  However, there is evidence that Nightingale applied similar rigorous controls over the lives of nurses in the Crimea as she did later in her career. Nightingale’s priorities lay with the micro-management of nurses’ lives rather than their professional training, focusing on their lifestyle and moral conduct rather than the development of technical skills.  F B Smith suggests that ‘she preferred patronage, and surveillance of nurses’ lives, to guiding their professional work.’[xix]  Colleen Hobbs, in her book, Florence Nightingale proposes that her suggestions for maintaining nurse discipline were at times ‘draconian’.[xx] Bradshaw highlights the high value which Nightingale placed on character training.[xxi]  There is evidence that Nightingale attributed high significance to the moral dangers faced by nurses in hospitals, rather than their exposure to medical conditions.  Although Victorian anxieties about moral danger were relevant to Nightingale’s radical approach of utilizing female nurses in army hospitals, exposure to critical medical practice, particularly in the Crimea, would have been extreme.

War provides opportunities for structural re-alignment and the conflict in the Crimea was an example of a chance to redefine the role of women.  Guy Small, in his work Florence Nightingale, Avenging Angel, identifies this impending role change. If women managed the high risk environment of an army hospital, the argument for using female nurses in London teaching hospitals would be a robust one.[xxii]  Nightingale exploited the opportunity to advance the profession of nursing and give women the chance to lead more useful lives.  She had propagated this theory before the war.  According to Hobbs, however, this opportunity was conducted in an atmosphere of distrust and suspicion[xxiii] and  F B Smith’s examples of evidence of the oppressive treatment of staff also make this point.  The following is a nurse’s account from the Crimea in 1854 ‘we are treated With the Greates disrespect and unkindness by Miss nightingale.’  The nurse illustrates inconsistencies by highlighting the better food enjoyed by the nuns while the housekeeper ‘all but starves us an is very hurtful to our feelings.’[xxiv]  Similarly, a second letter noted, ‘wee are all so very unappey Miss Nightingale have sum spite against us but for wat cawse wee know not.’[xxv]   These letters were most likely written by working class nurses.  They highlight clear inequalities in the treatment of staff and don’t offer any confidence that Nightingale was attempting to further the cause of the ordinary woman.  On the contrary, the relationship between Nightingale and her nurses is likened to that of an oppressive Victorian mistress and her servants. However, Cecil Woodham-Smith, in his work, Florence Nightingale, 1820-1910 takes the view that traits in the nurses in respect of drunkenness and immorality necessitated such treatment.  Woodham-Smith refers to the drunkenness and promiscuity of the nurses throughout his text.  For example, he writes, ‘The hospital nurse, drunken, promiscuous and troublesome, considered that her function was to tend her patient’s sick body,’[xxvi]  but the nurses’ letters yet suggest characteristics of poor communication skills, bullying and a lack of confidence building on behalf of Nightingale and her staff.  

 

The significance Nightingale attached to the control of nurses is compared to her absence of guidance on clinical skills in her later writings.  According to Small, Nightingale, by the late 1850s, ‘cared precisely nothing for the survival of hospital nursing as a profession.’[xxvii] And Hobbs claims that Notes on Nursing ‘offers surprisingly few descriptions of actual nursing.’[xxviii] It is also useful to examine sources such as the performance reports on the Probationers at the Nightingale schools.  These are identified by Monica Baly in her work As Miss Nightingale Said.  Comments by Nightingale from these reports were read out at the Assemblies of Probationers by a member of the Nightingale Fund from 1872 onwards. Baly has extracted the reports on eight probationers and records this selection as an ‘unwitting testimony’ to firstly, class consciousness of the day and secondly, to the fact that Nightingale’s life of isolation had left her out of touch with women in 1880.[xxix]  The testimonies illustrate a third point.   Although the extracts may not provide an accurate cross-section of the nature of the comments written about the probationers, they reflect Nightingale’s priorities and the qualities she was looking for in a good nurse.  Apart from one report of a probationer being ‘in want of ward training’ and another of ‘intolerable’ bed making skills, there is no record, in Baly’s sample, of progress or otherwise with respect to clinical training.  The remainder of the comments on the probationers refers to personal faults. ‘A vulgar mind’ and ‘Light in her conduct of men.’ are examples.[xxx]  Interestingly, in Nightingale’s comments on the diaries written by the probationers themselves she claimed that they had omitted descriptions of their clinical training.  She wrote, [of the probationers’ diaries], ‘They offer not the slightest clue to what the place is doing as a training school.’[xxxi]  The flavor of the combination of these two sets of records indicates that the nurses themselves gave low priority to skills training.

Most biographers have identified Nightingale’s apparent breakdown after her return from the Crimean War in 1856.  As she became a reclusive invalid, she continued her work in army reform and the development of nurse training through delegation, letter writing and the completion of her report on the high mortality rate of soldiers in her hospitals in the Crimea. Small’s analysis concludes that she came to the realization that the high death rate was actually due to poor hygiene rather than, as she originally believed, the poor physical state of the soldiers on arrival at the hospital.  Subsequently, she became consumed by guilt, which caused her to delay the implementation of the Nightingale Fund (set up in gratitude after the Crimean War to support the continuation of her work on nursing reform), and remained a reclusive invalid for many years.[xxxii]  Woodham-Smith chronicles her breakdown similarly but gives prominence to her frustrations at being unable to activate army reform, rather than her guilt as the cause of Nightingale's breakdown.[xxxiii] Woodham-Smith takes a sycophantic approach to Nightingale’s illness as he does with her handling of the nurses in the Crimea.  He exalts Nightingale for rallying to the cause of army reform, writing, ‘It [travelling to inspect barracks and hospitals] would have been hard work for a woman in good health; that Miss Nightingale could perform it in her physical condition was unbelievable.’[xxxiv] Hobbs also acknowledges her debility and uses the quality of her writings as evidence of a breakdown by comparing To the Artizans of England to its re-write, Suggestions for Thought which she completed after her return from the Crimea.  Hobbs describes the latter as loosely organized, rambling and repetitive.[xxxv]  Finally, Rosemary White, in her work Social Change and the Development of the Nursing Profession chooses not to detail Nightingale’s life but offers an interesting contrasting perspective on the motive behind Nightingale’s delay in using the Fund’s resources.  White admires Nightingale for the reason for her delay, giving her more time ‘careful consideration.’[xxxvi]

The theory about Nightingale’s guilt over the cause of the high mortality rate among Crimean soldiers requires further investigation.  The mortality rate started to decrease following a visit by a government led Sanitary Commission four months after Nightingale and her nurses arrived.  Whereas Nightingale had focused her attempt to improve the hygiene in the hospital by washing and delousing the men and their clothes, members of the Commission had the resources to improve sanitation and hygiene by flushing out the sewers, burying dead animals and draining and paving the hospital environs. These actions would have been relevant in reducing the death rate. Although Nightingale may not have realized at the time that her endeavors at improving conditions were less effective than those of the Commission, she would have not have had the resources made available to the Sanitary Commission and therefore was at least partly exonerated from blame.   It is unlikely therefore, that guilt alone was responsible for a breakdown which lasted for more than ten years (although the duration of her illness will be investigated later).  Woodham-Smith’s explanation for the cause, but not the duration, of her breakdown is plausible.  Her writings indicate her initial frustration at not being able to incite the government into moving more swiftly towards army reform, a project which had been crucial to her on her return to England.  She had written in a private note in August 1856 (the month of her return to England) ‘If I could only carry one point which would prevent one part of the recurrence of the colossal calamity, then I should be true to the brave dead.’[xxxvii]  Other biographers take a different perspective on Nightingale’s illness. Desiree Edwards-Rees, in her book The Story of Nursing, maintains that the illness allowed her to work undisturbed, receiving the visitors she chose.  Edwards-Rees highlights her achievements under these conditions, stating, ‘From her sofa she set up Royal Commissions, forced cabinet ministers to do her bidding and drove her slaves beyond endurance. … She conceived the idea of coaching others to speak but never appearing’[xxxviii]  due to her fear that her popularity would create jealousies.

After the war ended and before returning to England, Nightingale had written,

‘To return either sounding our own trumpet, or, viler still, attacking the system under which, and because of which we worked, can only at one degrade ourselves and justify … the common opinion that the vanity, the gossip and the insubordination of women ….make them unfit and mischievous in the service.’[xxxix] 

This cautionary approach, made between the end of the war in March and her return in August 1856 and her previously quoted comment on the prevention of another calamity are contradictory.  It is unclear which statement was made first, but the meaning of the private note differed from the words she expected to be widely read.   On her return to England, it appears she chose to apply a public acquiescent façade.  This indicates that she was aware of her own vulnerability and was beginning to make a case for her reclusion. 

Edward-Rees claims that by seeing visitors as she chose was an efficient way of maximizing Nightingale’s time and energy.   She records that dignitaries and royalties ‘waited upon her at her chosen hour for just as long as she decreed’,[xl] but does not acknowledge that these conditions placed Nightingale in control of the people around her.  Lytton Strachey, in his work Eminent Victorians also writes on the effectiveness of her illness. ‘She found the machinery of illness hardly less effective as a barrier against the eyes of men than the ceremonial of a palace.’[xli]   Strachey describes a typical interview with Nightingale.

‘Sometimes word came down that Miss Nightingale was just well enough to see one of her visitors.  The fortunate man was led up, was ushered, trembling, into the shaded chamber, and, or course, could never afterwards forget the interview.’[xlii] 

F B Smith uses a letter written by Nightingale’s secretary Aunt Mai in 1858 to suggest Nightingale’s façade, ‘She had ‘very little treatment in the way of a water cure.’ However, this would be expected; Nightingale had scornfully defined the cure as only a treatment ‘for the tedium of life and an indefinite disease which a large income and unbounded leisure are so well calculated to produce’[xliii], ‘but the comparative quiet makes it very suitable for her.’[xliv] Similarly, Harriet Martineau also suspected the convenience of Nightingale’s illness.  She sent a sardonic note to Nightingale in 1865, challenging her ill health.  Following the visit of a mutual friend, Martineau wrote;

‘Julia [probably Julia Ward-Howe] has written that your face is deceptive, - that wld make uninformed people suppose you to be much less suffering than you are.’[xlv]

F B Smith also provides evidence that Nightingale’s niece, Rosalind Nash, after seeing her outside, probably in the 1880s, wrote ‘We should have kept out of the way … because of her health ... she flushed at seeing us … She had been sailing along down the little glade.’[xlvi] Gillian Gill, in her book Nightingales; Florence and her family also comments on sightings of Nightingale outside her home in the 1880s[xlvii] which can be correlated with F B Smith’s narrative on the observations of Nightingale’s niece, although each biographer attaches discrete significances to these occasions.  Gill concludes that the sightings of Nightingale out of doors are proof of a recovery whilst F B Smith interprets her reaction at being observed as evidence of a façade of illness. Both standpoints may be correct and context dependent.

Letters to Florence Nightingale support Strachey’s tone in describing an attempted meeting with Nightingale.  Correspondence written in July 1871 to Nightingale by Mary Carpenter, the founder of schools for Indian girls begins,

‘I know that you cannot see anyone except on hospitals but your letter to Bengal … my friend has taken so much practical interest in these [sanitary matters] ... but that I cannot but hope that you can grant him an interview which he would very greatly prize.’

In the same letter Carpenter requests a meeting on behalf of another contact.  She continues, 

‘I know you only receive one visitor at a time … I cannot but hope that you may like to see her and afford her the privilege of seeing you. Hoping that you are … well now that dreadful war is over [probably the short war between Germany and France in 1870, during which  casualty aid activities were under Nightingale’s direction]. Yours always truly ...[xlviii]

Carpenter’s letter supports Strachey’s suggestion that Nightingale saw one visitor at a time.   Both extracts well epitomize Nightingale’s dominant position.  Nightingale was in control and as Carpenter acknowledges, she was selective in who she received.

Other letters written to Nightingale in the early 1870s reveal the commanding nature of Nightingale’s posture.  In 1871 Sir Bartle-Frere, Governor of Bombay who was instrumental in Indian Sanitary reform had attempted to see Nightingale in October 1871. Bartle-Frere wrote ‘I hear that there is any chance of your being able to see me … when I have the pleasure of seeing you.’[xlix] Similarly Sir John Laurence, Viceroy of India wrote in May 1874 ‘I would call to see you but I hear you are confined to your bedroom.’[l]  In 1877 Frere tried to see Nightingale again, writing twice within a week. On 2 February he wrote;

‘Will there be any chance of my finding you disengaged and able to give me a few minutes ... have been so battered about in different directions that I have been unable to ask you to let me see you.’[li]

On 7 February he wrote again, ‘When may I call with a hope of seeing you.’[lii] Bartle-Frere had worked closely with Nightingale on Indian sanitary reform during the 1860s, meeting daily for two months during 1867.  However, he was taking a submissive stance a further ten years into the relationship.      

The evidence purported by her niece, Rosalind Nash identifies that Nightingale’s implied debility lasted up to fifteen years. However, a letter dated October 1892, twelve years after her niece reported the incident with Nightingale outdoors, reads;

‘Dear Aunt Florence Is it too bad to propose it when you are so busy … On the way back from Oxford … It would be so good to see you, not only for business ...’[liii]

Although the letter is incomplete, her step-niece or nephews or their spouses, with whom she was close, can be implicated as the authors. It suggests that Nightingale was manipulating those around her, including members of her family, for a period of up to forty years after her return from the Crimea. Again, this time span dilutes the argument that Nightingale’s reclusion was due to her guilt over the Crimean fatalities.

As already established by F B Smith and Strachey and backed by the primary sources of correspondence from Aunt Mai and Harriet Martineau, there is evidence to prove that Nightingale’s illness was believed to be spurious, and as long as it continued, provided her with the means to control her associates.  Another point on Nightingale’s reclusion is worth noting.  In October 1854, Mrs. Gaskell, who was a distant relative of the Nightingale’s, wrote a letter from Lea Hurst, where she was staying with Nightingale. Gaskell wrote ‘She has no friend – and she wants none. She used to go a great deal among the villagers here, who dote upon her. … She will not go among the villagers now because her heart and soul are absorbed by her hospital plans.’[liv]  This letter was written before the Crimean War.  It illustrates that Nightingale’s reclusive characteristic did not manifest itself as a result of her guilt over the mortality rate in the Crimea.  

Having established Nightingale’s dominance over nurses and her business associates for a period of up to forty years it is revealing to explore more closely Nightingale’s interactions with the women closest to her; her mother and sister.  Some biographers do not identify any link between her illness and her management of family difficulties.  Small, on the other hand, reveals that Nightingale’s own explanation for the trigger for her breakdown was her family, although he questions the validity of this explanation.[lv]  

It is significant to investigate Nightingale’s own theory that her family, or possibly more distinctly the relationship she held with her sister and mother was the major contributory factor to the cause of her illness, rather than as previously purported, her guilt following the outcome of the investigation on the cause of the deaths during the Crimean War.

Nightingale and her sister Parthenope (Parthe) lived within diverse parameters.    For example, Parthe’s limitations are identified in a letter written to her in the summer and dated 10 July 1852, six years before her marriage and three years before Florence’s journey to the Crimea. The letter writer states ‘Don’t over fatigue yourself with a horrid long journey, pray.’[lvi]  Three years later, at approximately the same age as Parthe, Florence commenced the journey to the Crimea at the start of winter, and in Parthe’s words, ‘as calm and composed as if she was going off for a walk.’[lvii]  Nightingale always held that her family was insincere in affections towards her, writing in November 1856 ‘The person who went to Harley Street was to be cursed and the other [herself as returned from the Crimea] blessed …this false popularity has made all the difference in the feelings of my family towards me.’[lviii]  Despite Nightingale’s complaint to her father in 1861 that ‘I who for four years have never had a word of feeling from my family’[lix]  there is evidence that her family supported her in her work.   According to biographer, Gillian Gill the family ‘worked to make the philanthropico-political enterprise a success … Maintaining Florence became a clan project for three generations.’[lx] Nightingale was supported financially by her father and Gill also includes a revealing comment which offers another explanation why she expanded the duration of her debility into forty  years.  Her illness gave her independence. Whilst she was unwell Nightingale’s father supported her financially in independent accommodation. If she had recovered she would have been expected to adopt the dutiful dependant role as a single, Victorian daughter living in the family home.  Gill writes, ‘Had Florence Nightingale remained healthy it is unclear to what extent her father would have supported her work financially.’[lxi]  (In Cassandra Nightingale had proposed the theory that fathers should pass over a daughter’s inheritance at her coming of age.[lxii])  Parthe dealt with Florence’s correspondence both whilst she was in the Crimea and after she returned, lobbied home officials during the war on Florence’s behalf and hosted Florence’s overflow of visitors. Her husband, Sir Harry Verney, chaired the Nightingale Fund from 1861 onwards.  Some biographers have portrayed Parthe as an encumbrance to Florence.   Woodham -Smith for example, again taking a sympathetic approach toward Nightingale’s illness, wrote ‘To the burdens of over-work and ill health Miss Nightingale had … to add the care of an exacting and unreasonable invalid.’ [Parthe, when she became ill in November 1856.][lxiii] Parthe was a sketch artist, whose accomplishments during her lifetime included writing the memoirs of the Verney family during the Civil War, five novels and some essays on agriculture.  F B Smith differs from Woodham-Smith in taking a more complex perspective on Parthe.  F B describes Parthe as ‘a formidable rival’[lxiv], challenging Florence’s ideas whilst others chose not to.  A point about Florence’s relationship with her female relatives is worthy of note.  Biographers who report her mother and Parthe’s increasing ill-health and subsequent deaths of both between 1880 and 1890, link the timing with Florence’s apparent recovery but do not correlate the two sets of circumstances.  F B Smith writes that ‘the decrepitude of her mother and Parthe seemed to ease her private difficulties.’[lxv]  Woodham-Smith connects Parthe’s death and Florence’s improved health with her devotion to Parthe’s widower[lxvi]. Gill reports that with Parthe’s death Florence’s health began to improve.[lxvii]  Florence was critical of her female relatives, complaining in 1868 for example, that Parthe was ‘always, as she always had been, the spoilt child’ [lxviii] The cause of Nightingale’s illness is as yet unproved but she expected a pre-requisite of compliance from her associates.  As an authority on nursing, and as an invalid Nightingale could expect this compliance but it was not guaranteed in her relationship with her family.

It is helpful to examine the Nightingale philosophy in the context of other prominent nineteenth century female reformers. Firstly, Nightingale was not unique in designing a lifestyle for herself that would embrace her aims and objectives.  In the early 1850s Nightingale was introduced to Elizabeth Barrett Browning, the early feminist, poet and writer who gained a reputation as the reclusive ‘invalid of Wimple Street’.[lxix]  Barrett Browning remained an invalid, writing on progressive social and political issues until her recovery, which ran alongside her marriage and escape from her family in 1846. Harriet Martineau has been described by F B Smith as ‘an invalid who found that condition convenient.’[lxx] Secondly, Nightingale was a subsequent authority on nursing.  She succeeded Elizabeth Fry in stepping out of the wife and mother role to initiate nursing reform.  Fry, however, did not secure her standing by adopting the status of incapacity.  After giving birth to eleven children, by the year of Nightingale’s birth in 1820 she had become renowned as a prison and hospital reformer.  Fry was strongly criticized by the press for adopting this role and neglecting her home and family which signifies that the respectable family hierarchy as expounded by FM L Thompson existed before the Victorians made it their own.  Fry established the foundation for Nightingale’s work in opening a nurse training school at Guy’s hospital in 1840. It is worthy of note that Fry died in 1845, the year that Nightingale reported her call from God to work in hospitals. Fry’s death would have been widely reported, the two women corresponded and Fry nurses were among the group taken to the Crimea by Nightingale.  There is no record of any animosity between the two women and one can surmise that Fry had an inspirational effect on Nightingale in relation to nursing reform and the potential usefulness of women. 

Nightingale needed to have control over her associates.  Her teachings on obedience in relation to nursing reveal that she was aiming to create a profession based on an extension of the Victorian wife and mother role.  She attempted to present nursing and medicine as discrete professions by not supporting women’s movement into medicine.   She gave more significance to the lifestyle and moral conduct of nurses under training than to the development of their professional skills and her own reports and those of the nurses themselves, both in the Crimea and later in the training schools, indicate the qualities she was looking for and expected in a nurse. In the Crimea she held authority over the peripheral lifestyles of the nurses.   On her return from the Crimea she was vulnerable because the official report on the war identified the cause of death of the soldiers as the lack of hygiene in the hospital, for which Nightingale felt partly responsible.  After the Crimea, whilst suffering from fatigue and low morale, she discovered that her illness and the prolonging of it enabled her to maintain the control over her associates she had in the Crimea.  Her illness was a particularly effective tool used to maintain independence through her father’s financial support and without it she would have been under pressure to conform to the Victorian upper class female stereotype.  Her illness was also used as a means to control her family.  

To place Nightingale’s work in a wider context, an extract from a newspaper article printed in Cape Town in July 1877 and sent to her from Sir Bartle Frere well exemplifies the stigma that yet surrounded  hospitals and the priority given to the sick over twenty years after the Crimean War, and fifteen years into Nightingale’s attempts to elevate the value of hospital nursing.  The article discusses the placement of fish curing operations in the vicinity of Somerset Hospital, Cape Town.   A councilor had remarked, ‘…if people must be poisoned it is preferable to poison those who are half dead.’[lxxi] This standpoint illustrates nineteenth century priorities with regard to hospitals, and the value attached to medical care and the challenges Nightingale and her contemporaries faced in establishing hospital nursing as a worthwhile profession.     

Rosemary Leadbeater (formerly Smith) is a recent Masters  Degree graduate of Oxford Brookes University in the UK.  She is continuing her research on aspects of the History of Medicine.   For further information please contact rosemary.smith@brookes.ac.uk  

[i] E Cook, The Life of Florence Nightingale,1913 in C Hobbs, Florence Nightingale, New York, Twayne Publishers, 1997, p6

[ii] F M L Thompson, The Rise of Respectable Society; A Social History of Victorian Britain 1830-1900, London, Fontana Press, 1988, pp 63&85

[iii] G Small, Florence Nightingale: Avenging Angel, London, Constable, 1998, p179

[iv] C Woodham-Smith Florence Nightingale 1820 -1910, 1951,in C Hobbs, Florence Nightingale, New York, Twayne Publishers, 1997, p30

[v] F Nightingale, Suggestions, (draft) 1851-2 in F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p23

[vi] F Nightingale, Suggestions,( vol 2)1860 in  M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p12

[vii] M Vicinum and B Nergaad, Ever Yours, Florence Nightingale:Selected letters,1990, in C Hobbs, Florence Nightingale, New York, Twayne Publishers, 1997, p88

[viii] F Nightingale, Notes on Nursing 1859 in ibid, p88

[ix] British Library, Additional MSS in G Small, Florence Nightingale: Avenging Angel, London, Constable,1998, p69

[x] F Nightingale, Subsidiary Notes 1858, in C Hobbs, Florence Nightingale, New York, Twayne Publishers,  1997p88

[xi] F Nightingale, Notes on Nursing, 1859 in ibid, p88

[xii] Letter to Sir John McNeill, 1865 in M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p70

[xiii] Letter to John Stuart Mill, 1867 in M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p71

[xiv] F Nightingale, Notes on Nursing 1859, in B Ulrich, Leadership and Management According to Florence Nightingale, Connecticut, Appleton & Lange,1992, p56  

[xv] F Nightingale, 1879 in M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p97

[xvi] F Nightingale, Notes on Nursing, 1861 in A Bradshaw, The Nurse Apprentice, 1860-1977, Aldershot, Ashgate Publishing Ltd, 2001, p6

[xvii] F B Smith,  Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p18

[xviii] Wellcome Library, Letters to Florence Nightingale c1835-1898, 9 March 1887, 9030/67

[xix] F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p156

[xx] C Hobbs, Florence Nightingale, New York, Twayne Publishers, 1997, p75

[xxi] A Bradshaw, The Nurse Apprentice, 1860-1977, Aldershot, Ashgate Publishing Ltd, 2001, p8

[xxii] G Small, Florence Nightingale: Avenging Angel London, Constable,1998, p17

[xxiii] C Hobbs, Florence Nightingale, New York, Twayne Publishers,1997, p66

[xxiv] F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm,1982, p38

[xxv] Ibid, p39

[xxvi] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950, pp145

[xxvii] G Small, Florence Nightingale: Avenging Angel London, Constable,1998, p114

[xxviii] C Hobbs, Florence Nightingale, New York, Twayne Publishers, 1997, p65

[xxix] M Baly, As Miss Nightingale Said, London, Bailliere Tindall,1997, p94

[xxx] Ibid, p93

[xxxi] F Nightingale, Comments of Probationers Reports, 1896 in M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p94

[xxxii] G Small, Florence Nightingale: Avenging Angel London, Constable, 1998, p4

[xxxiii] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950, pp258-262

[xxxiv] Ibid, p283

[xxxv] C Hobbs, Florence Nightingale, New York, Twayne Publishers,  1997, p30

[xxxvi] R White, Social Change & the Development of the Nursing Profession, London, Henry Kimpton Publishers, 1978, p23

[xxxvii] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable,1950, p260

[xxxviii] D Edwards-Rees, The Story of Nursing, London, Constable Young Books Ltd, 1965, p50-51

[xxxix] F Nightingale, British Library, Additional MSS in G Small, Florence Nightingale: Avenging Angel, London Constable, 1998,p69

[xl] D Edwards-Rees, The Story of Nursing, London, Constable Young Books Ltd, 1965, p51

[xli] L Strachey, Eminent Victorians, London, Chatto & Windus, 1974, p178

[xlii] Ibid p179

[xliii] F Nightingale in G Small, Florence Nightingale: Avenging Angel, London, Constable, 1998, p12

[xliv] Aunt Mai to Lady McNeill in F B Smith, Florence Nightingale: Reputation and Power, London,1982, Croom Helm, p90

[xlv] Harriet Martineau to FN in F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p92

[xlvi] Rosalind Nash, ‘I knew a man’ in F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p93

[xlvii] G Gill, Nightingales; Florence and her family, London, Hodder & Stoughton, 2004, p462

[xlviii] Wellcome Library, Letters to Florence Nightingale c1835-1898, 15 July 1871, 9030/9,

[xlix] Ibid, 19 October 1871, 9030/12

[l] Wellcome Library, Letters to Florence Nightingale c1835-1898, 12 May 1874, 9030/16,

[li] Ibid, 2 February, 1877, 9030/18

[lii] Wellcome Library, Letters to Florence Nightingale c1835-1898, 7 February 1977, 9030/19,

[liii] Wellcome Library, Letters to Florence Nightingale, 1 October 1892 (incomplete) 9030/72

[liv] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable,1950, p128

[lv] G Small, Florence Nightingale: Avenging Angel London, Constable,1998, p126

[lvi] Wellcome Library, Letters chiefly to Florence Nightingale’s parents and sister, letter to Parthe Nightingale, 10 July 1852, 9034/44,

[lvii] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950,p142

[lviii] Ibid, p284

[lix] Letter from Florence Nightingale to her father, 1861, in M Baly, As Miss Nightingale Said, London, Bailliere Tindall, 1997, p67

[lx] G Gill, Nightingales; Florence and her family, London, Hodder & Stoughton, 2004, p436

[lxi] Ibid, p437

[lxii] C Hobbs, Florence Nightingale, New York, Twayne Publishers,1997, p37

[lxiii] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950, p284

[lxiv] F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p19

[lxv] F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p198

[lxvi] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950, p582

[lxvii] G Gill, Nightingales; Florence and her family, London, Hodder & Stoughton, 2004, p462

[lxviii] C Woodham-Smith, Florence Nightingale 1820 -1910, London, Constable, 1950, p517

[lxix] www.bl.uk/news/2006/pressrelease20060206a.html

[lxx] F B Smith, Florence Nightingale: Reputation and Power, London, Croom Helm, 1982, p92

[lxxi] Wellcome Library, Letters to Florence Nightingale, c1835-1898, Cape Town Council Report, 18 April 1877 included in letter from Sir Bartle-Frere, July 1877, 9030/27                              


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