Florence Nightingale, By Mark Bostridge

Nursing her grievances

Why another doorstep biography of Florence Nightingale? Do we not already know enough about the mellifluously-named nursing pioneer? Who became a national idol for her work during the Crimean War, a fierce opponent of the War Office and the founder of modern hospital practice? Who looked like a demure Victorian lady but acted like a matron-who-must-be-obeyed?

We have known of the idol's feet of clay ever since Lytton Strachey unpicked her reputation in Eminent Victorians. We are hazily aware that her bitter attacks on the imprisonment of young ladies in idle family pursuits are part of feminist history. We cannot be interested in the ramblings by which she, like her contemporaries, strove to reconcile the Christian God with terrible suffering. However, it is a long time since the last full-scale account of the Lady with the Lamp (as she hated to be known).

She was named after the city of her birth – luckier than her sister Parthenope, born in Naples – to well-to-do parents who resisted her do-gooding ambitions. Her cousin Barbara Smith, by contrast, had an allowance which enabled her to establish a ragged school, run the first campaign for female suffrage, and co-found Girton College. But the Smiths were illegitimate, so the Nightingales did not mix.

Florence grew from a contrary teenager, with intense fantasies of herself as a leading social reformer, into a frustrated young woman, blaming others for the obstacles in her path, and a mature woman who demanded absolute support. "She not only drops me," noted her aunt, "but imagination has been at work, abusing me". She hated rivals, calling Mary Seacole a woman of bad character who promoted drunkenness, when brandy was one her own chief medicines – but did apparently contribute to the fund saving Seacole from bankruptcy in 1857.

She could be spiteful and selfish. Disagreements, according to Benjamin Jowett, produced a "terrible hissing" like "water on red-hot iron". Sickness, aggravated by "overwork in the cause of Florence Nightingale", and even deaths, were unforgivable betrayals.

But her successes outweighed all failings. With a very small team, she brought order, clean laundry and better catering to the infernal barrack hospital at Scutari, despite the military, who saw "the Bird" as a meddler. Back home, she gave up direct action in favour of political persuasion, backed by facts, figures and unladylike verdicts on opponents. Her targets grew in scope: re-organisation of Army medical services; nurse training at St Thomas's; village sanitation and land tenancy in India; maternity wards and workhouse infirmaries in Britain.

The Blue Books multiplied – parliamentary commissions into every perceived problem. Nightingale was empowered by the Victorian passion for statistics, which she demanded be collected. As every campaign group knows, unrelenting pressure is the key. It came from Nightingale's bedroom, whither she retreated, suffering from what has recently been identified as brucellosis, probably from infected goat's milk. The symptoms are recurrent fever with spinal inflammation.

From bed, she wrote incessantly: letters, memoranda, instructions, diaries, drafts, idiosyncratic moral philosophy. Over 14000 letters survive and her published writings will fill 16 volumes. Her epistolary style, Mark Bostridge observes, combines open impatience and ruthless urgency with layers of courtesy and humility, all suddenly swept up into melodrama and exaggeration.

As he also notes, her biographer is in danger of being buried under avalanches of material. The papers found everywhere at her death, inside piano stools, under sofas, behind coal-scuttles, are also obfuscatory, fogging the nature of her achievements. Historians have debated these, and Bostridge offers a balanced synthesis of previous scholarship, insisting that her strengths lay in management not medicine.

She held to miasmic theories that disease was generated from foul air even after the identification of pathogens and, by later standards, her nursing practice was sound but limited, to routine, fresh air and cleanliness – although she would have felt vindicated by our return to the last of these in the battle against superbugs. For the rest, she assisted reform, and outshone others owing to her fame.

On personal matters, Bostridge argues that Flo's mother was lovingly bewildered, rather than socially snobbish. The sublimation of passions into intense professional loves and hates is unprobed, and no judgement is made about Jowett's alleged proposal, when both were in their fifties.

Overall, the picture painted in such greater detail is not dissimilar from Lytton Strachey's vivid sketch. In the end, the legend is historically more significant than the life. Many women and men who have made comparable contributions to public and national affairs have been rewarded with no more than a DNB entry. As the centenary of her death in 1910 approaches, Nightingale, one of the few Victorians with continuing name recognition, is in a league of her own.

Jan Marsh's biography of DG Rossetti is published by Phoenix