Florence arrived at Kaiserworth for the second time in July 1851 and was instantly transformed. She began each day at five o’clock and from then on she was in constant demand in a way she found most satisfying. But she had by no means cut the umbilical cord. A letter from Fanny was received rapturously – “It was the greatest possible relief to hear from you”24 – and brought an immediate response. “I am afraid my accounts of what I do would be very uninteresting to you,”25 she wrote but then followed a description of her working day which was far from uninteresting. She spent a lot of time helping with sick children and taking the convalescent ones for long walks along the Rhine. “The world here fills my life with interest and strengthens the mind and body,”26 she wrote. She only had ten minutes for each of the four daily meals and had no time to send her clothes to the wash. She went wherever she was sent to do whatever was needed in the hospital or the school and the variety as well as the obvious usefulness of her days made them happy. Thoughts of suicide were forgotten – “I should be sorry now to leave life – I know you would be glad to hear, dearest mother, this – God has indeed made life rich in interests.”27 By the end of August “I am as happy as the day is long,”28 she wrote. But what she still wanted, and did not have, was her parents’ total blessing. “I cannot bear to grieve you – life and everything in it that charms you you would sacrifice for me . . .”29 This was the crux of Florence’s problem: duty alone would never have kept her from following what she felt was a vocation. It was her own love, her deep love, for her parents and even more her realization of their love for her that prevented her acting. It would be foolish to represent the Nightingale parents as ogres, interested only in repressing their daughter. On the contrary, it was because they truly believed that nursing would repress her that they resisted it. How could their beautiful Florence find happiness and fulfilment as a woman if she buried herself in one of those disgusting hospitals? They were, they thought, saving her from a terrible fate, and Florence appreciated that this was what they believed. What she found herself incapable of altering was their concept of womanhood and what it meant.
She returned from Kaiserworth after three months, determined to convince them that her only chance of happiness lay in returning there, or somewhere similar, as soon as possible, but as soon as she got home her father contracted an eye infection and she immediately became his nurse. Thoughts of leaving were out of the question until her adored father was better. But as soon as he was recovered her sister Parthe fell ill. Florence turned from nursing her father to nursing Parthe (who said later “she was a shocking nurse”). She by no means adored Parthe, who had always irritated her, but the sense of commitment was the same. It was as though she had never been away. Kaiserworth receded as a vision and was replaced by the more accessible Convent of the Sisters of Charity in Paris. As soon as Parthe was better, she swore she would go to Paris and enter the convent to gain nursing experience. But Parthe did not get better, she got worse. Florence’s only bit of luck was that their doctor decided it was Florence who was making Parthe ill and that they ought to be separated. On Februrary 4th, 1853 Florence obeyed with alacrity. She arrived in Paris ready to begin nursing. Unfortunately, she was pursued by a telegram announcing her grandmother was now gravely ill and she had to go back, all arrangements once more cancelled. “There is nothing,” she once wrote “like the tyranny of a good English family.”32 Such families, like hers, bred daughters to reciprocate the love lavished on them and to answer the call of that love whenever it was made. Self must not be thought of. Daughters had an identity only within the framework of this family love whereas sons were given their wings to fly away as soon as they left childhood.
It took two actions outside her control to release Florence from the never-ending confines of family responsibility. The first was the offer of an actual job which forced her to make a clear decision. Up to 1863 she had always had to do the pushing herself – nobody pushed for her. But now she was asked to be the Superintendent of the Institute for Sick Gentlewomen in Distressed Circumstances. She could, of course, have turned it down on the same grounds as those which had always kept her at home but she knew that if she did so there really would be no hope left. For the first time a hand was being extended, a solid means of extricating herself from the morass of “duties”. If she spurned it, she was lost. So she accepted. And then a wonderful thing happened. Her father decided to make her an allowance of £500 a year. She could be truly independent. This gesture of faith made at such a vital moment gave Florence the courage to face the inevitable appalling scenes with her mother and Parthe. On August 12th, 1853, aged thirty-three she finally left home and took up residence in the Institute’s premises at No. 1 Harley Street. “It is,” she wrote triumphantly, “a fait accompli.”31
Within a very short time Florence was rather regretting those words. “I am now in the hey-day of my power,” she wrote to her father, adding, “Praise and blame are alike indifferent to me.”32 But she quickly saw that her new position was far from being satisfactory. Being Superintendent of the Gentlewomen’s Institute certainly did not train her as a nurse. It was primarily an administrative post and, though an excellent outlet for her formidable powers of organization, it taught her little about nursing. Once the run-down home she had inherited had been streamlined she was restless again. By January 1854 she was speaking contemptuously of “this little molehill”. She found herself trapped into endless negotiations to get things done and wrote, “I do all my business by intrigue.” It was not at all what she wanted to do and brought her only slightly nearer her real objectives which were to train as a nurse, make nursing a profession, and reform hospitals. She began to look around for another post, preferably in a real hospital. She began bombarding Sidney Herbert and lobbying Dr Bowman, one of the best-known surgeons of the day, to get herself made Superintendent of Nurses in the newly re-organized Kings Cross Hospital. Then, she could really show what she was made of.
But fate gave her a better chance. In the summer of 1854 a cholera epidemic broke out in London and Florence went to the Middlesex Hospital as a volunteer “to superintend the nursing of cholera patients”. There, she set a superb standard of care for others to follow. It was “sanitary” nursing at its best and, though she did not know it, a dress-rehearsal for the Crimea. Florence was then formally invited by the Government to go out to Scutari in command of a party of nurses to try to alleviate the terrible sufferings which were currently being exposed by The Times correspondent, William Russell. She accepted, but made quite sure that her authority was clearly defined. She had already had a little experience of being a woman working in a male-controlled world and knew that she must have unequivocal power in her particular sphere right from the start. So she had Sidney Herbert, Secretary at War since December 1852, put in black and white that “everything relating to the distribution of nurses, their hours of attendance, their allotment to particular duties is placed in your hands.”
Her official appointment by a Government minister was the first of its kind. Her family were stunned, caught between pride and terror, and even her influential friends were awestruck. “I hear you are going to the East,” wrote Richard Monckton-Milnes. “. . . you can undertake that when you could not undertake me.” Florence very nearly decided that she would have to undertake it on her own because she could find no other nurses of sufficient calibre to accompany her. Using the Herbert’s house as her headquarters she interviewed all the applicants herself and was disgusted by them. “All London was scoured for them,” wrote Mary Stanley who helped her. “. . . We felt ashamed to have in the house such women as came.” If Florence had needed any proof that nursing needed to be reformed this was it. The candidates she saw made her despise her own sex and produced more of those violently anti-feminist sounding statements which were in fact a mask for her passionate belief that women ought to get up and change their unsatisfactory lives themselves. She could not find, in that crisis, good women to be nurses, good women to sacrif
ice themselves for the greater good and yet everywhere women screamed they could find no employment. She had the means to give them employment so why did they not take it?
In the end, Florence left England in October with thirty-eight nurses who passed muster – but only just. (Twenty-four were nuns and she thought little better of them than of the others.) But she sailed in good heart, excited that at last she had a real, indisputable mission and enormously relieved finally to have gained her mother’s as well as her father’s blessing. The journey was long, the conditions bad and the arrival at the Barrack Hospital in Scutari horrifying. The filth, the mud, the wretchedly inadequate facilities, the hordes of wounded all added up to a vision of hell. It was much worse than anything Florence had imagined but her self-control remained rigid. She realized at once that nursing was the least of her problems. “I am,” she wrote home, “a kind of General Dealer . . . A whole army having been ordered to abandon its kit . . . I am now clothing the British Army . . . I am really cook, housekeeper, scavenger . . . washerwoman, general dealer, storekeeper.”33 She became as obsessed with cabbage soup and scrubbing-brushes as with dressing wounds and assisting at operations. But she had correctly realized that not only did these menial jobs have to be part of nursing in those circumstances but that they provided a way to gain the power she needed to achieve what she wished to achieve.
Upon her arrival the army authorities had resented her presence and so had the doctors. She had had the foresight to appreciate that, the system being what it was, there was nothing to be gained by challenging these men or setting herself up as a rival. She had to convert them to seeing she could help and was no faint-hearted lady sent to get in their way. So, although she loathed them, she set herself to work through these men with meticulous attention to the existing system. The Army operated through written chits. Very well, she would wait for instructions through written chits even though all around men were dying for want of simple care. She stopped her nurses rushing in and made them wait for orders. It was exactly the same tactics other women had to resort to in order to break down male hostility but nobody else was ever obliged to play this game in quite such earnest. Hurting male self-esteem was fatal. Her sole concern was to prove the value of women as nurses and to do so she was prepared to appear to be humble before the male authorities.
At last, her approach worked. After the battle of Balaclava all pretence that Miss Nightingale was not in charge of nursing (and much else) was over. “On Thursday last,” she wrote on November 14th, 1854, “we had 1,715 sick and wounded in this hospital (among whom 120 cholera patients) and 650 severely wounded . . . when a message came to me to prepare for 510 wounded . . . arriving from the dreadful affair of Balaclava . . . We had but half an hour’s notice before they began landing the wounded. Between one and nine o’clock we had the mattresses stuffed, sewn up, laid down – alas! only on matting on the floor – the men washed and put to bed and all their wounds dressed . . . The operations are all performed in the ward – no time to move them.”34 It was a scene of continual horror with Florence always at the centre trying to keep her vow that no man should die alone. The vision of her in white floating around with a lamp in her hand softly uttering kind words is not entirely a myth but it distorts the much more impressive truth. She never reached that end-of-the-day ritual without unremitting, backbreaking toil during which she came to hate almost all the men she had to deal with. “Alas, among the men here,” she wrote to Sidney Herbert, “is there one really anxious for the good of these hospitals? One who is not an insincere animal at the bottom, who is not thinking of going in with the winning side whichever that is?”35 She never said, “Women would not act like this,” but it was implicit in all her searing criticisms. She herself put the welfare of the men first and was furious if any of her party did not also do so. It was beyond her comprehension that any woman could actually come to her and complain that her cap didn’t suit her (as one did) or think of consorting with some of the less ill men in the wards (which became something of a problem). Women, so far as Florence was concerned, were on trial, they had something to prove, they had to be (as she herself was) beyond reproach.
After two years, when Florence Nightingale at last returned home, her sense of mission had shifted its centre. To reform hospitals and establish nursing as a profession were no longer her main objectives. Instead, she saw she had much more important work to do. It was her intention to see that never again would the British Army be in the mess it had brought upon itself in the Crimea. The whole organization of the health of the Army must be reformed and she must do it or have on her conscience forever the memories of all those thousands of soldiers who had died unnecessarily. Besides that, work for nursing was puny. Ill and exhausted as she was, she side-stepped the adulation that was hers, shut herself away (from 1857 onwards she spent long periods in bed or on a couch immured in her room) and at once began preparing a scheme to reform the health of the British Army. All her depleted energies went into writing to Ministers, powerful friends, even the Queen herself in order to get agreement that there should be a massive inquiry. She organized the Royal Commission and wrote a Confidential Report herself.
But meanwhile other people had not forgotten her old ambition even if she appeared to have done so. During the Crimean War a Nightingale Fund had been launched to enable Florence Nightingale, when she returned, “to establish and control an institute for the training, sustenance and protection of nurses paid and unpaid.” That fund now stood at £45,000 and was waiting for the attention she was not prepared to give it. A committee was approved by her to administer the fund and a secretary appointed but the work of setting up any kind of training-school for nurses hung fire while everyone waited for Miss Nightingale herself to tell them what exactly she wanted done. There was no doubt that the climate was right – the popular image of the nurse had been changed overnight, as it were – and the money was available, but no movement was made. Nobody knew how to proceed, how nurses should be trained and for exactly what and they waited in expectation of a Nightingale blueprint. What nobody realized was how difficult it was at that particular time to provide such a thing, even for Miss Nightingale.
Nursing, together with medicine, was at that time changing dramatically because of the scientific advances of the mid-nineteenth century. By 1846 anaesthetics were in use all over the western world and therefore the horizons of surgery were suddenly enormously expanded. There was so much more the surgeon could now do without fear of the patient dying of shock and therefore there was also so much more for the nurse to do. As well as “sanitary” nursing there now existed technical nursing in which the nurse had to become – or had the chance to become – the partner of the doctor. She could stop being primarily a handmaiden and become a colleague with her own skills. But what, in that case, should she be taught? Should a nurse follow much the same course as a medical student and if so where did that leave the medical students? Medical training itself was in a state of flux and was becoming a severely structured standardized business geared to tests and examinations and culminating (after 1858) in attaining registered status. At the other end of the scale was the question of what sort of menial tasks a nurse should be expected to perform. If she was to be a skilled colleague of the doctor should she, any more than he, be down on her knees scrubbing the ward floor? Nobody quite knew where nurses stood or what exactly they were and yet it was a matter of some urgency to decide. The number of girls and women wanting to become nurses after the Crimea was naturally large and with a conservative estimate of a million and a half spinsters and widows needing employment the establishment of nursing as a proper profession looked like the answer to a great many prayers. Suddenly, there was work, paid work, that a lady could contemplate other than governessing. Miss Nightingale was a nurse: the stamp of impeccable respectability had been put on a hitherto socially despised job.
The first meeting of the Council of nine men Florence Nightingale had appointed to take charge of the public m
oney collected was in December 1859. At this meeting the Council was formally entrusted with setting up an “Institution for the Training, Sustenance and Protection of Nurses and Hospital Attendants.” To guide them its members had only Notes on Nursing: What it is and What it is not, a short book published in the same month (price 5s) by Miss Nightingale. This was not intended to be a nursing manual or in any sense a text-book but merely a guideline to show which way nursing should go. Florence herself said she only wanted to make people “think how to nurse.” Practically every line struck a blow for the feminism she was meant to decry. “It has been said and written scores of times that every woman makes a good nurse,” she wrote. “I believe, on the contrary, that the very elements of nursing are all but unknown.” It was, she went on, quite ludicrous for example to imagine that to be a nurse all you had to be was female, as if the female sex automatically carried within it recuperative powers. It was equally silly to argue that making sick people better “ought to be left to the doctors”. That was only an excuse for ignorance. “Did Nature intend mothers to be always accompanied by doctors?” she asked sharply. “Or is it better to learn the piano forte than to learn the laws which subserve the preservation of offspring?” Nor was it any good bleating as mothers were prone to do, “But the circumstances which govern our children’s health are beyond our control.” What nonsense. All circumstances could be to some extent controlled: nobody could stop a cold east wind blowing but learning how to cope with the ill-effects of that wind was possible. This was what nursing was about: being practical and sensible and also imaginative. She had no time for anyone who saw themselves delicately dabbing a fevered brow. The image of a woman as frail, modest and gentle, a creature whose sensibilities must not be offended, was a curse on nursing. To be a nurse you had to be tough and unsqueamish and if that meant losing your femininity in the eyes of the world then lose it you must. Being a nurse had nothing to do with being “nice”. A straightforward discussion on chamberpots made her point forcibly. All chamberpots should be emptied and washed daily by the nurse. “If a nurse declines to do these kind of things for her patient,” she wrote, “because it is ‘not her business’ I should say that nursing was not her calling.” She thought, in fact, that it was a waste of manpower for nurses to do it and she had no wish to see nurses as drudges, but, if they had to do it, then they must and “women who wait for the housemaid to do this or for the charwoman to do that when their patients are suffering have not the making of a nurse in them.”
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