In the historical literature, reformers tend to be overlooked in favour of revolutionaries as subjects of biographies, but Nightingale emerges from this book as a heroic and surprisingly modern figure in the field of health care reform: idealistic but pragmatic, she had no time for theory while people were dying of easily preventable disease—she just wanted to know what actually worked to reduce infection and death rates, and promoted these changes with all the political capital she had built up during the Crimean campaign, using her privileged background and fame to gain access to government officials who were able to effect her reforms.

Nightingale's concept of health care was very broad, and led her to promote many progressive causes: an early feminist who worked to make nursing a respectable, well-paid occupation (previously, nurses were little more than untrained hospital cleaners); aware of the starvation in India caused by Britain's laissez-faire policy, she became an opponent of liberal economics and promoted something like Keynesian counter cyclical government spending and broadly conceived of a recognisably modern welfare state; she worked to raise the standard of medical care available in workhouse infirmaries so that even the poorest people would have the same level of care as everyone else.

Most appealing to me is Nightingale's use of data analysis to present her argument. She was ultimately an empiricist and honest enough to go where the data went, and willing to change her mind when the data went elsewhere. This to me is the most modern aspect of her work and personality. Not everyone has the courage and stamina to fight for the issues she fought for, but we all have the capacity to look honestly at the evidence and make our decisions based on that.

This isn't really a biography, but more of a short (200 pages) overview of Nightingale's contributions to health care reform in Britain and Commonwealth, with plenty of direct quotes from her letters and government reports. It is about as useful an introduction to her life as we can expect.

I came to Florence Nightingale at First Hand knowing very little about the subject (I knew that at some time in her life the lady had been in posession of a lamp and was rather fond of nursing, but that was about the extent of my knowledge). So I picked up this book as an introduction to Nightingale, and it should be held in mind that my thoughts here are written from that perspective.

The preface makes clear that this book is in part a response to works hostile to Nightingale (F. B. Smith's Florence Nightingale: Reputation and Power and its followers), accusing such works of containing false accusations and so being dishonest. This was my first inkling that this might be a poor choice as an introduction. Indeed to some extent this suspicion proved true as the book is littered with such rebuttals throughout, leaving me feeling at times, ignorant as I was, as a child must feel when he walks in on his parents arguing over some adult business: confused and wondering what all the fuss is about.

I did however gain a valuable insight into Nightingale's work and character, as between these periodic counter-claims a nice little biography has been written. From my initial state of ignorance I now know something of Nightingale's strong religious motivations, her work on hospital reform and her role in the early development of nursing in Britain and abroad, her quest to transform the workhouse infirmaries, her work in statistics and her creation of the pie chart, and of course her role in the Crimean War. Yet, while Nightingale is undoubtedly worthy of much praise, I feel that McDonald sometimes goes a little too far. For example she notes not only that Nightingale should be seen as a major contributor to nineteenth century social reform (with which I would have to agree) but, further, that she should be considered a sociologist on par with the likes of Karl Marx, Emile Durkheim, and Max Weber. I think, at least from what I have read in McDonald's book, that this is crediting Nightingale with a little too much.

As for the book itself, the reliance on Nightingale's own writings lends it obvious authority as well as a personal feel. The various subjects covered are on the whole well organised if a little fragmentary in places, and the inclusion of a Dramatis Personae and A Quick Sketch of Florence Nightingale's Life just after the preface is something I found very useful and is something from which I think more biographies would benefit from utilising.

So my final thoughts? Clearly this was not the best choice as an introductory text, but I know far more about Nightingale after reading it than I did beforehand, which is really all I was looking for.