Lambert “was a cheery man in company but shyish of being looked at.” By pure force of character he had overcome his shyness, and the shame and discomfort of his size, to become a national hero. Today, the local tourist office proudly bills him as “Leicester’s largest son.”

The relaxed jollity that Daniel Lambert managed throughout his short life would elude Florence Nightingale (1820–1910) until the very end of hers. Most people now have an inkling that the “ministering angel” or “Lady with the Lamp” image hides a more complex reality, but it still comes as a shock to learn that she spent more than half her life not as a nurse but as an invalid, much of it bedridden in her Mayfair flat.

The precise nature of this illness has been the cause of much speculation. She did her best to keep up appearances and would, on most days, get washed and dressed before retiring to the bed again, ready to receive a maximum of one visitor a day, if strictly necessary. But she also kept herself manically busy. Perpetually armed with a pen and writing paper, she produced books, papers, and a stream of correspondence with her family and famous friends, starting her working day as early as 5 a.m. In her life, she wrote more than fourteen thousand letters, although many of the most personal ones she marked “Private. Burn.” Most of what we now associate with her—the foundation of modern nursing practice and improved standards of hygiene—were products of her years in bed rather than her brief stay in the Crimea. In the century since her death, biographers and historians have variously accused her of malingering, of strategic invalidism in order to manipulate others, of hypochondria, and even of neurotic lesbianism. More charitably, she has also been retrospectively diagnosed with post-traumatic stress disorder, manic depression, schizophrenia (because she claimed to hear God’s voice), and chronic fatigue syndrome.

The medical evidence all points to the fact that she was properly ill. Her physical symptoms are consistent with the bacterial infection we now call brucellosis (then known as Crimea or Mediterranean fever), which she probably picked up by drinking unpasteurized milk while working in the military hospital during the war. Without treatment it leads to long-term health problems, consistent with those that Florence Nightingale experienced in later life. From 1861 to 1868 she was especially unwell, and had to be carried from room to room. Her own descriptions of her symptoms are terse but telling. In 1863 she complained of “over pressure of the brain”; in 1865, it was “rheumatism of the spine and right elbow.” That year she also experienced “great breathlessness,” and in 1866 “spasms of the lungs.” By 1867, she was “bereft of an ounce of strength,” and in 1868, “felt as if the top of my head was blown off.” In 1879, she complained of “rapid palpitations” and “ninety hours without sleep.”

But these physiological symptoms, though undoubtedly real, masked a strong psychological component. Her compulsive attitude to work and desire to hide from the world were the outward expression of an inner turmoil that stretched back deep into her childhood. Florence’s early life was apparently happy and balanced. Her parents were kind and loving and the family was well off, with houses in Derbyshire, Hampshire, and London. Her parents’ home was part of a lively intellectual scene that encompassed theologians, social reformers, historians, and artists. The Nightingales were Unitarians, liberal Christians who believed in a single, beneficent God, but also in science and progress. William Nightingale had named his younger daughter Florence after the city of her birth, establishing it for the first time as a popular name for girls. Until then it had been a boy’s name. Her sister, born a year earlier in Naples, got saddled with Parthenope, the Greek name for that city, which (so far at least) has not caught on to the same extent. William undertook the education of his two daughters himself, and it was apparent from the start that Florence was academically exceptional: brilliant at languages, arts, and sciences. This, however, was to prove a constant source of tension in her life. For much of it, she was by far the brightest person in any room and she knew it. “I must overcome my desire to shine in company,” she wrote in her diary while still a teenager. She was also attractive. The novelist Mrs. Gaskell described her as “tall, willowy in figure, [with] thick shortish rich brown hair, a delicate complexion, and grey eyes that are generally pensive but could be the merriest.” Her profile in the Times makes her sound almost too perfect: “a young lady of singular endowments… her attainments are extraordinary.”

Florence Nightingale didn’t have the horrors of poverty, neglect, or abuse to contend with, yet she was plagued by fits of depression and suicidal self-loathing—a typical diary entry reads “In my thirty-first year, I see nothing desirable but death.” The source of her unhappiness was her deep sense of being at odds with the stultifying social requirements and hypocrisy of the world she had grown up in. Far from the stiff-collared, sharp- tongued martinet of popular legend, the young Florence was like the heroine of a Mrs. Gaskell or George Eliot novel: fiercely bright, passionate, and headstrong. She was desperate to be loved, but couldn’t bear the idea of falling into the same polite, bourgeois trap as her parents:

It is not surprising that husbands and wives seem so little part of one another. It is surprising that there is so much love as there is. For there is no food for it. What does it live upon—what nourishes it? Husbands and wives never seem to have anything to say to one another. What do they talk about? Not about any great religious, social, political questions or feelings. They talk about who shall come to dinner, who is to live in this lodge and who in that, about the improvement of the place, or when they shall go to London…. But any real communion between husband and wife—any descending into the depths of their being, and drawing out thence what they find and comparing it— do we ever dream of such a thing? Yes, we may dream of it during the season of “passion,” but we shall not find it afterward. We even expect it to go off, and lay our account that it will. If the husband has, by chance, gone into the depths of his being, and found there anything unorthodox, he, oftenest, conceals it carefully from his wife,—he is afraid of “unsettling her opinions.”

This passage is from a book called Cassandra, written when she was in her early thirties but, on the advice of her learned male friends, never published. At various times a novel, a philosophical dialogue between two sisters, and a heartfelt polemic, it is the most complete statement of her belief that only work would make sense of her life. It is one of the great feminist texts of the nineteenth century, intellectually and emotionally intelligent but so raw that later writers found hard it to swallow. Virginia Woolf acknowledged its influence but thought it “a shriek of nervous agony.”

The more of Florence Nightingale’s work one reads, the more one senses that had she been born a man, she might have become a great moral philosopher like John Stuart Mill or a respected historian like Thomas Carlyle (both of whom admired her writing). Instead, she grew up in a household where men idly theorized and women wasted their lives “looking at prints, doing worsted work and reading little books.” Acutely conscious as a child of the suffering of the Victorian poor, from the age of six she set her mind on “a profession, a trade, a necessary occupation, something to fill and employ all my faculties.” Only this could liberate her “from the accumulation of nervous energy which has had nothing to do during the day” and which makes women feel “every night, when they go to bed, as if they are going mad.”

At the age of sixteen Florence had a religious experience in which “God had called her to his service.” This didn’t mean fiddling around doing charity work at her local church: It meant using her hands and brain to right the wrongs of the world. She asked her parents if they would support her intention to go into nursing. They were horrified and refused. In fact, her mother, Fanny, fainted at the shock of what her youngest daughter was suggesting. “We are ducks,” she later lamented “who have hatched a wild swan.” So Florence continued to live at home and tried to escape the glacial atmosphere in the house by plunging herself into a study of mysticism. Over the next decade, she would develop her own theology, which she outlined in another book that was destined to remain unpublished, Suggestions for Thought to the Searchers after Truth among the Artizans of England. Her studies took her far beyond the shores of Christianity—one wonders how many other English women in the 1850s would ever conceive of writing to a friend: “You must go to Mahometanism, to Buddhism, to the East, to the Sufis & Fakirs, to Pantheism, for the right growth of mysticism.” At the same time, she dutifully fulfilled her social obligations and entertained a string of enthusiastic suitors.

Her most persistent male admirer was Richard Monckton Milnes, a literary patron and minor poet, who was also the MP for Pontefract. He was a good friend of Tennyson’s, the first biographer of John Keats, and the man who introduced the work of Ralph Waldo Emerson to Britain. On the face of it, he was the perfect match for Florence: clever, well connected, and wealthy. He obviously thought himself the right man for the job: He patiently paid court to her for nine years. She was also clearly tempted by him:

I have an intellectual nature which requires satisfaction, and that would find it in him. I have a passional nature which requires satisfaction, and that would find it in him. I have a moral, an active nature which requires satisfaction, and that would not find it in his life. Sometimes I think I will satisfy my passional nature at all events,

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