The Real Florence Nightingale

18 Jul 2019. Bob Kaplan

I had only the haziest idea of who Florence Nightingale was—a Good Samaritan, I thought, tending to soldiers in some long-ago war. "The Lady with the Lamp," as she was called in a poem written in her honor by Henry Wadsworth Longfellow in 1857. I didn't even know she was a nurse, and, in truth, "nurse" doesn't come close to describing what she accomplished over her long career. When I read the brilliant, carefully researched, deeply insightful character study of Nightingale by Lytton Strachey (pronounced Stray-key) published a century ago, I was amazed by the force and fire of her and sobered by the personal costs.

Florence Nightingale made her reputation in the mid-1850s during the Crimean War by taking a make-shift, woefully unequipped and under-staffed, shockingly unsanitary hospital for 1,500 wounded or dying British soldiers and muscling it into shape.  A monumental uphill struggle every step of the way. A lesser person would have given up. She worked like a dog—ceaselessly, indefatigably. And she fought like a warrior. Without any formal authority over the hospital, which was located just outside Constantinople, she nevertheless wielded powerful influence, both locally and in England, that would not be denied. And slowly but surely, conditions at the hospital improved, the troops' morale rose, the mortality rate fell.

Her career itself was no less improbable. Hailing from an aristocratic family, she broke the mold by refusing to marry, to the great dismay of her family. It was the constraints of a conventional upper-class marriage that she walked away from. Her passion to be useful in the world, a pressing moral imperative dating back to childhood, burned too hot for her to give up unfettered independence.

After the war, she returned to England to great acclaim. But, for her, the triumph in Constantinople was merely a first step, just a springboard to reform on a much larger scale. The army's behind-the-times medical system, the sorry state of nursing, the backward design of hospitals—that and more were in her ambitious, fact-based, clear-eyed reformist sights.

But as a woman she was impeded. A Royal Commission was formed to investigate the Army's health and, though its very formation was a victory for her, as a woman she could not serve on it. At the time such a thing was unheard of. It would be another 70 years before women in England were able to vote.

Sidelined, at a disadvantage, she still managed to be a force to be reckoned with, to say the least—in fact, to prevail. ‎Despite poor health, she did her own investigation and wrote her own report in just six months, 800 closely reasoned pages, that "laid down vast principles of far-reaching reform" and ‎became the very basis of the eventual Report of the Royal Commission. 

‎Her fame was a huge asset, "an incalculable force"  in Strachey's words. So were her connections, with the queen who honored her upon her return, and with Prince Albert, a fellow technocratic progressive thinker. She was also, thanks to her family's aristocratic place in society, tied into ‎the highest reaches of government; part of the same set as Cabinet ministers and Peers. 

Chief among those was Sidney Herbert, a close friend going back to childhood, who was "convinced from personal experience in charitable work of her supreme capacity." He became her years-long sponsor, expediter, surrogate. It was Sidney Herbert, holding a powerful position in the War Office, who recruited her for the wartime assignment, and it was Sidney Herbert more than any other individual who got her the supplies the hospital desperately needed and who cleared away otherwise insurmountable obstacles in her path. Finally, her wealth came in handy. When, for example, even Herbert couldn't free up urgently needed funds to expand the hospital by 50 percent‎ in order to receive, with little notice, 500 additional wounded soldiers, she was able to fund it herself.

‎What came of the Commission's recommendations? She saw to it, through four sub-Commissions, that they were acted upon. ‎"Barracks and the hospitals were remodeled, properly ventilated, warmed and lighted: the Army's medical statistics‎ were reorganized, as was the Army Medical Department; an Army Medical School was established."

She went on to professionalize the field of nursing, to that point a thoroughly disreputable line of work. Her "Notes on Nursing" set down principles and practices and, on that basis, she opened the first nursing school. To this day she remains an inspiration, not just to nurses but to men and women serving in any medical capacity in wartime.

Florence Nightingale, then, was a larger-than-life thought leader, innovator and institution-builder, all the more remarkable for a woman at that time. But it came at a steep price. 

‎She sacrificed her health. At the Constantinople hospital she collapsed from feverish overwork and almost died. Back home and again a total wreck, she ignored her doctors' directives and her family's pleas. She refused to rest. Still in her 30s, she never regained her health. Yet she lived on and worked hard for decades. The costs of her relentlessness even extended to Sidney Herbert who‎, ever-responsive to the excruciating pressure she continually placed on him, went to an early grave.‎

"A demon possessed her," explained Strachey. "She moved under the stress of an impetus that finds no place in the popular imagination."‎ In a weakened condition, bedridden, she would not let up. "A demonic frenzy" overtook her. Her upside and downside were intertwined. As Strachey pithily put it, "the force that created was the force that destroyed."

And yet, what high achiever is this not true of? The pulsating, fierce drive to mastery is a decidedly mixed blessing. Only the proportions vary. The ultimate question, of course, is: what's the net-out? In the case of Florence Nightingale, there doesn't seem to be a question that the price, however regrettable, was worth it—to society.

Still, if she had allowed herself to be persuaded to rest when she was gravely ill, she might have conceivably accomplished even more. But there's the rub. Obsessively strongminded pioneers like her—or like Steve Jobs who stubbornly refused medical treatment for pancreatic cancer in favor holistic remedies—are notoriously difficult to influence.

In that regard, something Strachey wrote about another prominent public activist and writer also applies to Florence Nightingale and, indeed, to all driven leaders: "The elements of darkness and the elements of light lay crowded together, fold within fold."

*"Florence Nightingale" in Strachey's Eminent Victorians.‎ Just 70 pages, fireworks all the way. Here's the link: