In response to:

The Mysterious Miss Nightingale from the March 8, 2001 issue

To the Editors:

How much did Miss Nightingale know?

In her article “The Mysterious Miss Nightingale” [NYR, March 8], Helen Epstein quotes Dr. Lynn McDonald as saying that I have not consulted unpublished material that might show that Florence Nightingale understood during the first winter of the war that bad sanitation was the cause of the high death rate. This implies that in my book Florence Nightingale, Avenging Angel I relied on the absence of any earlier reference by Nightingale to sanitation problems as evidence that she did not accept their importance until after the war. But I did not rely on such evidence, and it would be very dangerous to do so when so much correspondence has been destroyed. Instead, I quoted a letter that Nightingale wrote during the war in which she denied that conditions at Scutari were to blame for the deaths, and other unpublished letters she wrote soon after her return in which she attributed the high death rate to other causes.

There has been a tradition of asserting that Nightingale was already a sanitarian when she arrived at Scutari but no evidence has ever been presented for this. If any new material is found showing that she was already blaming sanitation during the first winter, it might show that Nightingale was inconsistent but would not invalidate my claim that she officially opposed this explanation.

To assume that every intelligent person was a sanitarian in 1854 is to trivialize the challenge that Nightingale and her supporters faced after the war. Chadwick’s inability to convert intelligent people to his cause was legendary, as shown by his dismissal and the collapse of his Board of Health in 1854 to widespread public rejoicing. Nightingale’s exposure to Chadwick’s ideas before the war appears to be minimal. In the only direct reference I have found in her unpublished correspondence she mentions in 1846 his scheme for reducing the urban consumption of soap by piping soft water from a distance. Chadwick, in an approach worthy of Mr. Gradgrind, had worked out the soap costs to the penny without apparently impressing on Nightingale any idea of the health benefits of piped water. It is interesting to compare Nightingale with her relative and contemporary Barbara Leigh Smith Bodichon, who published a sanitarian tract as early as 1848, having been exposed to more unconventional thinkers than Nightingale including Southwood Smith, a family friend who was a close associate of Chadwick.

Hugh Small
London, England

To the Editors:

I am grateful for Helen Epstein’s review of my recent biography, Florence Nightingale: Mystic, Visionary, Healer, and for her comments that the book is “beautifully illustrated” and “clearly written.” However, her view that the book is “puzzling” and presents “nothing new” about Nightingale’s life is itself perplexing.

Ms. Epstein seems to have missed the premise of the book—that Nightingale was an authentic, genuine mystic, according to criteria developed by respected scholars such as Evelyn Underhill, and that her multifaceted contributions were empowered by her deep sense of unity with God. Nightingale first heard God speak to her at the age of sixteen, an experience that was repeated on three other occasions later in her life. Her sense of unity with the Absolute, which is the universal hallmark of the mystic, was the driving force in her life and the source of her “must.” Nightingale’s mystical side was not trivial or casual, and she cannot be understood without taking it into account. Her mystical writings are as sublime as those of many medieval female mystics such as Saint Theresa and Hildegard of Bingen. Previous biographers have mentioned her mystical drive only in passing or not at all. Instead they seem to prefer, as Ms. Epstein, to take a rather sanitized view of her character—Nightingale as a precocious, energetic public health worker.

Ms. Epstein seems also to have overlooked other new elements in my book, such as the recent evidence that Nightingale’s invalidism may have been due to chronic brucellosis, an infectious disease contracted during her period of service in the Crimean War. This evidence is vital, because of the habit of many biographers to paint Nightingale as a Victorian neurotic who, having made a name for herself, took to bed for the rest of her life because of psychological difficulties. New material also unnoticed by Ms. Epstein concerned Nightingale’s involvement with young Indian nationals who were beginning to lead India’s struggle for independence. This late chapter in her life is virtually unknown. Its importance can be seen in the tribute Mahatma Gandhi paid her when she died in 1910, as I pointed out.

Ms. Epstein’s review was focused narrowly on the contributions Nightingale made to the field of public health. These were magnificent accomplishments, as the world knows. Nightingale’s life, however, was richer and deeper, and her contributions more glorious, than is conveyed by these well-known facts. To ignore how her life burned with a passionate desire to know God, and how she ached to carry her received vision into the world, perpetuates the stereotypical image of “the lady with the lamp.” Nightingale was far more, and she deserves better, than this image or Ms. Epstein’s review suggests.


Barbara Montgomery Dossey
Director, Holistic Nursing Consultants
Santa Fe, New Mexico

To the Editors:

Helen Epstein in her most informative “The Mysterious Miss Nightingale” rightly referred to my sixteen-volume Collected Works of Florence Nightingale as being “abridged.” Readers might be interested to know, however, that as well as the printed volumes, which are selective indeed, there will be full publication, in electronic form, of all Nightingale’s previously unpublished and published works. Material has been gathered from more than a hundred archives worldwide, and we suspect that there are further letters, perhaps in small private, university, or hospital collections in the United States, that should be included. (Anyone with letters is asked to get in touch! e-mail:

The electronic publication will also include massive databases, a chronology, and background information on Nightingale’s correspondents and co-workers in her various causes. Epstein I am sure is right in surmising that new biographies will be prompted by the availability of this new material. The electronic publication will make it possible for the first time for scholars (and anyone interested) to search the entire Nightingale oeuvre for sources in their area of interest. Material has already been made available on a pre-publication basis to other scholars. For more on the project visit our Web site: www.sociology.

Epstein’s article was particularly interesting on Nightingale’s work on the broader social issues of Poor Law reform. The fifth volume in the Collected Works, Society and Politics, will have a great deal of previously unpublished material on these broader social issues: housing (and its connection with ill health); income security for the working class (including savings banks, pensions, and various self-help schemes); and measures to facilitate home ownership among workers. These issues have scarcely been discussed in the scholarly literature on Nightingale to date.

Finally, please note that this very large project still has space for further participants.

Lynn McDonald
Professor of Sociology
University of Guelph
Guelph, Ontario, Canada

Helen Epstein replies:

Hugh Small and Barbara Dossey seem to have come away from my review with a few misunderstandings, which I will try to clarify. In response to Hugh Small, I agreed with the argument he makes in Florence Nightingale: Avenging Angel that Nightingale was almost certainly not a sanitarian before she went to the Crimea, nor did she seem to realize that poor sanitation was killing so many soldiers in her hospital during the winter of 1854–1855. I did not assume that Nightingale was a sanitarian before 1854, and I thought Mr. Small’s arguments were sound and convincing. Mr. Small will realize this if he has another look at what I wrote.

The question I raised was, “why not?” Why wasn’t she a sanitarian? Why didn’t she immediately realize the cause of the soldier deaths at Scutari? I don’t think this is a trivial question. Nightingale must have known about the London cholera epidemics and the debates about their causes, since she had friends on the Board of Health and the issue was discussed in the newspapers and was much talked about. She also cared about the health of the poor even before she went to the Crimea. Could it be that she and those advisers and friends she was closest to were repelled by Chadwick’s political and economic views, so vividly described by Christopher Hamlin in Public Health and Social Justice? Chadwick is often thought of as a hero of public health, but his cold-blooded attitudes toward the poor may have delayed acceptance of his sounder public health ideas, by Nightingale and others.

I also wonder if Barbara Dossey read the same review I wrote. I said her book contained “little” new information, not “nothing new.”

I mentioned the brucellosis hypothesis, and I credited its originator, who was D.A.B. Young, not Ms. Dossey. I did mention that Florence Nightingale supported Indian self-rule. Lynn McDonald wrote about this two years before Florence Nightingale: Mystic, Visionary, Healer was published, although Ms. Dossey did provide more detail on this fascinating subject.

Regarding Florence Nightingale’s spirituality, I wrote that she was very concerned with religion, and the entire final section of the piece deals with her ideas about God. Whether she was in fact a mystic is something I wouldn’t know. However, my feeling is her actions were motivated more by the political and scientific developments of her time than by directions from God.


This Issue

May 31, 2001