INTRODUCTION
The idealistic, thirty-one-year-old Florence Nightingale whom Elizabeth Gaskell describes in her letter of October of 1854 had not yet been put through the fire of directing hospital nursing in Scutari. She had yet to learn the ins and outs of attempting to produce reforms from within enormous government bureaucracies, and she could not have know how much influence her own story would have on the societies in which she lived and the people in whose lives she took an interest.
While the young woman Gaskell depicts was almost certainly less politically savvy than she would be after the decades she spent working largely behind the scenes to enact health, economic, and other social reforms; nonetheless, the spiritual, scientific, and philosophical beliefs that grounded Nightingale's activism throughout her life were already in place. As the chapters that follow illustrate, the root of Nightingale's beliefs was her faith in the existence of a benevolent God, whose gift to humanity was the laws of nature and society that He established. In her hardly orthodox view it was a principal part of God's plan that humankind should discover the laws of society the same way they did natural laws, by the detailed observation of phenomena in the world (the numbers of suicides, of crime, of deaths by famine, etc.). after the relevant facts had been gathered throught observation, she claimed, the science of statistics offered the most efficient way to use those observations to uncover the laws that govern the particular phenomena observed. Despite challenges of all sorts and from various sources throughout her long career, her belief in God's benevolence and His willingness to reveal His laws to those willing to look for them is steadfast throughout her work on sanitation, Poor Law reform, and economic and health reforms in India.
Once these laws of nature and society were discovered, she was confident that humanity could use its knowledge of these laws to govern society according to ideals of health, community, and sympathy. While she clearly expected that observations of phenomena in the world would bear out her ideals, she appears to have arrived at many of these ideals from her extensive reading, as a young person and throughout her life, in philosophy (particularly Plato), religion, and the classics, as well as in the literature, science, medicine, and social science of her day. This social science, particular the burgeoning interest in sanitary statistics, led her to a rather surprising blending of the empiricism of a Comtian positivism with what she herself thought of as the essence of Christian theism: laws of nature ascertainable by mankind. A good example of her allegiance to the natural and social science of her day can be seen in the fact that, instead of believing in the efficacy of miracles, or angels and devils, she became in her public writings a long-time dogmatic opponent of contagionism -- the view that diseases were caused by invisible particles called germs, rather than observable features of the environment -- indeed holding belief in germs to be a form of superstition akin to belief in angels and devils.
I stress the spiritual, philosophical, and literary foundations of Nightingale's views here for important reasons. Despite the frequent emphasis this book places on Nightingale's social and political savvy and her willingness to adopt in her public writings the narrative and rhetorical strategies developed and/or made popular in fiction, Nightingale always viewed her arguments about politics, philanthropy, reform, and the like, whether in public or private writings, as entirely consistent with her philosophical and religious views. They ground her work in a way that belies any notion that she was "simply" an empiricist, a utilitarian, or even a positivist thinker. She was also not simply an idealistic and sympathetic nurturer of soldiers, "the lady of the lamp" in popular images from the period.
As we shall see in the chapters that follow, Nightingale shared ideals about governance and reform in common with reformist essayists, philanthropists, and novelists of her time, but she also challenged the views of many of these important writers on philosophical and scientific grounds. Her critiques warrant our attention, especially given the enormous, and until recently underappreciated influence she had on reformist ideals and methods following her return from the Crimea. Most people today who know her name still know nothing of her close advising relationships with and influence on members of the Victorian British war office, government sanitary and hospital reformers, poor law reform activists, not to mention the government commissions that came into being as a result of her behind-the-scenes efforts, and the scale and impact of many other of her reformist efforts, far too numerous and far reaching to mention here.
Chapter 3 Competing Visions: Nightingale, Eliot, and Victorian Health Reform
By the mid 1860s, Nightingale had acquired a degree of moral authority in the general public as a result primarily of her widely documented work in the Crimea. But she had also earned the respect of many in government and intellectual circles, through her largely behind-the-scenes work on issues related to the sick, the poor, and women -- including work-house reform, hospital design, retraining women for careers in nursing, and army and hospital sanitary reform. Some of the leading female reformers and novelists of her day including Harriet Martineau, Elizabeth Blackwell, Elizabeth Gaskell, and philanthropist Angela Burdett-Coutts, had offered their support to Nightingale's reform efforts by helping to find resources for soldiers, to retrain manufacturing women to be nurses, and, using Nightingale's sanitary statistics and documents about training the military in sanitary principles to write editorials favorable to Nightingale's views in popular periodicals such as the Daily News.
There were three types of reforms; however, that Nightingale was reluctant to get behind publicly despite the urgings of some of her prominent female reformer friends. She resisted endorsing the three following initiatives: advocating for women's suffrage, opening medical education to women; and supporting medical reforms of particular kinds that, she felt, drew intellectual and financial resources away from sanitary studies. One might have imagined -- given her well-documented comments in her correspondence, "Cassandra," and elsewhere about the stifling lives that most women of her day led -- that Nightingale would have agitated enthusiastically for votes for women and for women's right to enter into the field of medicine. Likewise, her interest in assembling "the facts" about disease in order to save lvies through sanitary studies would suggest that she would have supported research of any scientific kind into the nature of disease.
None of these assumptions would be correct. The previous chapters of Victorian Medicine and Social Reform: Florence Nightingale among the Novelists have described Nightingale's willingness- despite her feeling that fiction distorted the truth through sensationalism and sentimentalizing -- to draw from the rhetorical and narrative strategies of novelists in order more effectively to influence public opinion in favor of her reform ideas. This chapter considers the rather different feelings provoked in Nightingale by a novelist whose prolific intellect and genius for realist description had earned the kind of respect among Victorian writers, including Nightingale herself. George Eliot's method of respresenting her fictional worlds according to her dazzlingly wide-ranging reading in the works of her scientific, medical, and philosophical contemporaries was particularly evident in Middlemarch. It created, for Nightingale, not only what Catherine Judd has described as "a competition for the role of social prophet" between the two women; it also created withering challenges to many of the scientific and philosophhical principles on which Nightingale's own authority on public health issues had been based.
To be sure, Nightingale never explicitly acknowledged the threat that Eliot's status as social and scientific sage posed to her own. She based her objections to Middlemarch both in public and private writings primarily on what she saw as Dorothea Ladislaw's failure at the end of Middlemarch to imagine a means of contributing to the public good in any way other than serving as helpmeet to her aspiring politician husband Will Ladislaw.
EPILOGUE: NIGHTINGALE IN THE TWENTY-FIRST CENTURY: THE LEGEND VERSUS THE LIFE
Throughout researching and writing Victorian Medicine and Social Reform, I have thought about how best to explain what Florence Nightingale's legacy might be in the twenty-first century. There is no one way to describe her complex legacy. The breadth and depth of her knowledge about social problem in Britain, India, and elsewhere, and the broad effects of her reformist work seem to be all but unknown to the general public today; the name "Florence Nightingale" in my hearing has often been used almost as an insult to describe women perceived by the speaker to be either overly empathetic busy-bodies or obsequious caregivers wanting attention for their effors. Perhaps it's then no wonder that in 1999 Unison, the larget British trade union representing nurses, decided it was time to disassociate their profession from her example, to "exorcise the myth of Florence Nightingale". As I hope this book makes evident, recent scholarship on Nightingale's life and work has attempted to broaden the popular perception of her out from narrow iconic perceptions of her as either the self-sacrificing ministering angel to the troops during the Crimean War or as the stern, unforgiving bureaucrat who professionalized nursing. The Collected Works of Florence Nightingale, edited by Lynn McDonald, along with Mark Bostridge's fine biography, Florence Nightingale: The Making of an Icon, and Jharna Gourlay's Florence Nightingale and the Health of the Raj are only a few of the most recent examples of excellent archival scholarship now offering a much richer picture of Nightingale as an intellectual, a reformer, and a person. But that scholarship does not always make its way into the public eye in any form other than reviews, a point that Nightingale, with her sophisticated sense of how public opinion is often generated, would no doubt have recognized. Even Bostridge's carefully nuanced and meticulously researched biography, which was highly praised by its critics, elicited dismissive conclusions about Nightingale herself. Reviewing Bostridge's book for The Independent, Jan Marsh concludes of Nightingale, "In the end, the legend is historically more significant than the life." And the reviewer for The Atlantic wraps up his or her review with the sweeping conclusion that Nightingale was "a woman to whom we owe a great deal, but would perhaps never want to meet." Both comments seem to reflect a desire to sum up her life in sweeping terms; and both risk putting off readers who might forget the reviewers' prior compliments about the book in the interest of not bothering themselves with learning more about an ultimately unlikable person.
Reviews such as these prompt me to question why my perceptions of Nightingale, the person, and the importance of her work to current social, economic, and health policies in Britain and abroad should be so entirely different to what we find in these two reviews. Her insightful and thorough methods of gathering information and her gifts for presenting that material to government officials and to the public in ways calculated to make the most impact would, on its own, seem important enough to suggest that Nightingale's work is at least as important as her legend. It seems terribly ironic given Nightingale's scrupulous decision not to give her name to causes to which she did not also give her work that anyone in the twenty-first century should find her name, and the legend it appears to invoke, "more historically significant" than the voluminous amounts of work she did in the interests of making life better for the poor, sick, and the colonized. In making this claim I do not mean to suggest that others' contributions to the kinds of reform work Nightingale undertook in Britain, India, and elsewhere are less notable or less laudable than Nightingale's; and I regret that critical attention on her lfie and work may have overshadowed the work of Indian reformers in particular; but I do want to insist that Nightingale's contributions -- her work both behind the scenes and in the public -- should play a larger part in her legacy than the fading iconic images of her as either the ministering angel or the stern bureaucrat.