Florence Nightingale at First Hand (review)

A confession is in order—although I am a historian of nursing (and a former nurse), this book is the first full publication that I have read on Florence Nightingale. Researchers working in Canadian nursing history are often impatient when confronted with the celebrated icon of professional nursing, preferring to give at least equal credence to the foundational work of the many French and French-Canadian réligieuses (i.e., nuns) in developing nursing in this country. This book, however, goes well beyond a simple focus on Nightingale’s influence on the nursing profession to offer a succinct, accessible, and convincing entry into the complete range of her broad interests in social and health reform.

Lynn McDonald, the author of this book, is on a mission. Her stated purpose in writing is “to present Nightingale first hand as an author, systems thinker and pioneer public health reformer” (xii). But, while acknowledging (and dismissing) previous hagiographic portraits of Nightingale, she is also clearly taking aim at authors she claims have been “cynical,” “sexist,” and just plain wrong in recent assessments of Nightingale and her significance. Arguing that reporting “first hand” from Nightingale’s writings—that looking at “what she in fact wrote and did”—will refute some of the criticism now in circulation about Nightingale, she wants to set the record straight about her “groundbreaking achievements” for a new audience that she feels is mostly unaware of the sheer volume and breadth of her work (xiv–xiii). While many historians might be somewhat uneasy about the implicit search for “truth” in primary sources that this aim implies, one has to respect the authority with which McDonald approaches her subject. As an editor of thirteen (so far) of the proposed sixteen volume set of the Collected Works of Florence Nightingale, McDonald has read through the woman’s prodigious output that contains upwards of 10,000 letters as well as numerous articles, pamphlets, books, and reports scattered over 200 different archives. It is unlikely that any other researcher can claim the same depth of knowledge about Nightingale’s writings and what they reveal about the direction and development of her ideas over time.

McDonald begins the narrative with a brief description of the familiar contours of Nightingale’s life, sketching her early life of privilege, her struggle to find meaningful work in nursing, her Crimean war experiences, her subsequent invalidism (which McDonald contends was likely due to chronic brucellosis contacted during the war), and her long productive life that was conducted mainly from the confines of her room until the infirmities of old age prevented further work. She then follows with two rather eclectic chapters that outline some of Nightingale’s various perspectives on family life, women, society, politics, and religion, as well as her development as a social reformer. Nightingale’s adept use of statistics, which led her to becoming the first woman admitted to the London Statistical Society in 1858, bolstered her credibility as a social science researcher. Situated within the larger context of religiously motivated reformers informed by a rising interest in scientific principles, McDonald argues, too, that Nightingale’s Christian faith—deeply felt but broadly liberal—was completely intertwined with and inspired her drive for social reform. Throughout her life, Nightingale remained guided by the philosophy that the world as it stood was a “created” world governed by both natural and social laws, both of which were “the work of God and . . . open to human discovery by induction from research results” (30).

McDonald breaks the rest of the book in four thematic chapters that discuss, among other things, Nightingale’s views on the health of armies, the training of nurses and their practice, the care of the sick poor, and the sanitary conditions, especially in India but also throughout the Empire. She demonstrates that Nightingale, despite her illness, devoted an enormous amount of energy to keeping up with her voluminous correspondence, to organizing behind-the-scenes strategizing, and to mentoring both nurses and...