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Victorian Medicine and Social Reform, by Louise Penner
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Vic t or i a n M e dic i n e a n d
S o c i a l R e for m
Fl or e nc e Nigh t i ng a l e a mong
t h e Nov e l ists
Louise Penner
VICTORIAN MEDICINE AND SOCIAL REFORM
Copyright © Louise Penner, 2010.
Softcover reprint of the hardcover 1st edition 2010 978-0-230-61595-3
All rights reserved.
First published in 2010 by
PALGRAVE MACMILLAN®
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ISBN 978-1-349-37955-2 ISBN 978-0-230-10659-8 (eBook)
DOI 10.1057/9780230106598
Library of Congress Cataloging-in-Publication Data
Penner, Louise.
Victorian medicine and social reform : Florence Nightingale
among the novelists / Louise Penner.
p. cm. — (Nineenth-century major lives and letters)
Includes bibliographical references and index.
1. English prose literature—Great Britain—History and criticism.

2. English prose literature—19th century—History and criticism.
3. Nightingale, Florence, 1820–1910—Inﬂuence. 4. Nightingale, Florence,
1820–1910—Political and social views. 5. Social problems in literature.
6. Medicine in literature. 7. Literature and society—Great Britain—
History—19th century. 8. Literature and medicine—Great Britain—
History—19th century. I. Title.
PR878.S62P46 2010
823⬘ .809355—dc22 2009035775
A catalogue record of the book is available from the British Library.
Design by Newgen Imaging Systems (P) Ltd., Chennai, India.
First edition: May 2010
10 9 8 7 6 5 4 3 2 1
For my family
C on t e n t s
Preface ix
Acknowledgments xix
Introduction 1
Chapter 1 Defending Home and Country:
Florence Nightingale’s Training of
Domestic Detectives 9
Chapter 2 On Giving: Poor Law Reform, Work,
and Family in Nightingale, Dickens, and
Stretton 37
Chapter 3 Competing Visions: Nightingale, Eliot,
and Victorian Health Reform 75
Chapter 4 Engaging the Victorian Reading Public:
Nightingale and the Madras Famine
of 1876 109
Epilogue: Nightingale in the Twenty-first Century:
The Legend versus the Life 147
Notes 155
Bibliography 175
Index 185
P r e fac e
International news and entertainment media chronicle the

trials of actress Nicole Kidman in marriage, in motherhood
to two adopted children, and in trying to become pregnant
with her first biological child. Yet she acts as United Nations
Ambassador for worldwide women’s rights. Angelina Jolie’s
role as member of the UN High Commission on Refugees pro-
duces artful image after image of the wiry mother of six (and
counting) hammering boards for shelters, smiling maternally
over wide-eyed African children. In 2008, Madonna, Gucci,
and UNICEF forged a partnership to sponsor Madonna’s
celebrity-filled benefit party for their joint charity, “Raising
Malawi.” The title of the charity proposes the same kind of
parental relationship (“raising”) that celebrities perform in
their Ambassador roles.1 Rich, maternally oriented actresses
help attract public sympathy toward populations whose experi-
ences of famine, disease, and untold other hardships produced
by war, unstable governments, and exploitive economic condi-
tions, rarely appear even in the brief captions that accompany
the celebrity images.
Audrey Hepburn, a longtime UNICEF Ambassador,
may have set the contemporary standard for waif-like celeb-
rities advocating on behalf of starving children. But, Sally
Struthers’s much-parodied, commercials on behalf of the
Christian Children’s Fund provided one of the first tele-
vised opportunities for middle-class people to adopt their
own parental roles toward a child in a developing country.
Struthers tearfully pleaded with viewers to sponsor poor chil-
dren, from whom, she promised, donors could expect letters
of gratitude, but whom they need never meet and the sources
x P r eface
of whose economic, social, and health problems they need

never comprehend.
Of course maternal activism has always had its perils.2 In
Bleak House (1854), Charles Dickens leveled his satirical wit
at middle-class women social reformers in the figure of Mrs.
Jellyby whose “telescopic philanthropy,” focused aggressively
on Africa, allows her to forego providing maternal affection
and care to her neglected children and husband at home.
Dickens’s hyperbolic portrait of Mrs. Jellyby, a veiled attack
on the work of Victorian female emigration activist, Caroline
Chisholm, represented the potential dangers to the moral
authority of prominent Victorian women if they strayed too
far from the maternal ideal in their activist personas.
Following her return from the Crimean War, having served
heroically as Director of Nursing in the British military hospital
at Scutari, Florence Nightingale, the most famous female celeb-
rity social reformer of the Victorian period, wrote sentimentally
to friends about acting in the role of mother to her soldiers, as
if to confirm in private the public, iconic image of her as the
self-abnegating nurse maternally tending to the wounded. Like
twenty-first-century celebrities, Nightingale was aware of the
power of her celebrity to inspire others to parental sympathy for
the less fortunate; but she also knew the downsides of that sen-
timental celebrity for a woman whose critique of current social
policy was well-informed, complex, and keenly felt.3
Despite her friendship with Dickens, who, with Angela
Burdett-Coutts, helped procure and send a “hot closet,” or
drying machine, to Nightingale at the Barrack Hospital in
Scutari,4 Nightingale defended her friend Chisholm to others.
Nightingale would have been vulnerable to similar critiques
with respect to her work on reforming Poor Law workhouse
administration and Indian famine prevention. Like Mrs. Jellyby
and unlike Dickens, who famously as a child suffered immedi-
ately the consequences of the new poor law,5 Nightingale had
never lived as part of the populations for whom she advocated.
She never even visited India despite her forty years of engage-
ment with issues of Indian sanitary reform, famine prevention,
and Indian home rule.
P r eface xi
It would be a mistake, however, to confuse Nightingale’s

participation in social causes with that of twenty-first-century
celebrity mothers, even the best informed of them. Their
celebrity is their chief weapon and they brandish it lavishly
in the interests of raising public interest in important causes.
Nightingale, by contrast, came to use her celebrity sparingly;
moreover, unlike many maternal celebrity philanthropists, she
insisted on having a detailed knowledge base about the causes
to which she gave her public endorsement and she chose to
endorse publicly only those causes to which she was also will-
ing to give her work. She calibrated the type and level of her
engagement in each of these causes according to deeply con-
sidered views of how to be most effective in influencing social
policy so as to make a practical difference in the lives of the
poor, sick, and colonized populations in whose interests she
worked after her return from the Crimea.
Victorian Medicine and Social Reform describes how
Nightingale’s public and private writings, as they worked
both to confirm and complicate her iconic maternal image,
contributed to the development of social and medical poli-
cies in Victorian Britain. Publishing popular tracts encourag-
ing women to learn to nurse properly at home, as Nightingale
did in Notes on Nursing (1860) and Notes on Nursing for the
Labouring Classes (1861), according to the best medical and
scientific information she had, would not arouse public or
political opposition. But swaying the British public and politi-
cians toward her views of broad government policies related
to health, poverty, and colonial governance would require a
different rhetorical approach. She developed that approach in
ways that responded to the development of social realism in
the Victorian novel.
Condition of England novelists conveyed their commen-
taries on Victorian medical, social, and economic problems
to a broad popular audience in ways that combined idealistic
moral instruction with richly detailed accounts of social condi-
tions. Amanda Anderson has described the tension in George
Eliot’s realism between representing the unglamorous, accu-
rate details of unexceptional lives and providing, through the
xii P r eface
narrators of her essays and novels, models of ideal sympathetic

relations that encourage social change in a better way than did
studies based in statistics and other forms of social science.
These proto-sociological studies, Anderson argues, offer the
observer only an unsatisfyingly distanced perspective on indi-
viduals and societies.6 Victorian Medicine and Social Reform
describes how, by the end of their careers, this combination in
narrative of idealist prescription and local, detailed, informa-
tion drawn from a kind of “ideal participant-observer” narra-
tor appears in the works of Nightingale; Eliot; Dickens; their
contemporary, the lesser-known Hesba Stretton; and their
influential predecessor Elizabeth Gaskell.7 Eliot, Nightingale,
Gaskell, and Dickens read each other’s work, corresponded
with and about each other, and influenced each other’s rhetor-
ical and narrative strategies. Their writings made significant
contributions to ongoing disputes in Victorian intellectual
and political circles about the kinds of evidence necessary to
sway public opinion regarding the industrial and imperialist
crises enveloping Victorian Britain. In the process, they nego-
tiated their own public personas in part through comparison
and contrast with each other’s public and private images and
writings over the courses of their long careers.8
In tracing the impact and reciprocal influence of
Nightingale’s life and work on her public image and the writ-
ings of Victorian novelists, such as Gaskell, Eliot, Dickens,
Wilkie Collins, and Hesba Stretton, Victorian Medicine and
Social Reform builds on a diverse body of Nightingale schol-
arship. In her time, the Victorian press and public celebrated
her as the self-sacrificing “lady of the lamp,” heroine of the
Crimean War, about whose care and compassion for injured
soldiers others wrote in terms reserved for living Saints.
Biographers, such as Lytton Strachey and especially F. B.
Smith, by contrast, have provided twentieth-century readers
with a counter image of Nightingale as a self-interested, cal-
lous, and fame-seeking opportunist. More recently, literary
critics such as Mary Poovey, Catherine Judd, and Elaine
Freedgood have created a portrait of Nightingale as the mil-
itaristic and idealistic champion of the professionalization of
P r eface xiii
nursing and of social reforms backed by statistics-based sani-

tary research. Early in her career, she aggressively championed
statistics as the science that “alone of all others gives us the
exact results of our experience.” 9 Jharna Gourlay has uncov-
ered previously untapped archival resources on Nightingale’s
later efforts to influence British colonial policies on Indian
sanitary reform and famine relief. Recent biographies by Mark
Bostridge, Hugh Small, Barbara Dossey, and Gillian Gill have
also unearthed archival resources to help provide a more com-
prehensive portrait of Nightingale’s life and prolific career.
But sociologist Lynn McDonald’s projected sixteen volume,
Collected Works of Florence Nightingale, has, more than any
other resource, begun to fill an enormous gap in the schol-
arship on Nightingale’s work. McDonald generously shared
pre-publication materials on Volumes 10 and 11 with me.
As I describe the influence on Nightingale of the novelists’
evolving ideas about the kinds of evidence necessary to prompt
government and popular efforts on behalf of the poor, sick,
and the colonized, I am fortunate again to be able to draw on
rich critical traditions. Among the mountains of scholarship on
Gaskell, Eliot, Dickens, and Collins are cogent treatments of
the relationship between medical thought about disease origins
and means of transmission and the development of realism by
Laurence Rothfield and Jeremy Tambling. Both invoke Michel
Foucault in describing how the increasingly disciplinary nature
of nineteenth-century medical authority influenced Eliot’s
realist narrative in Middlemarch. Janis McLarren Caldwell’s
more recent comparative analysis of Middlemarch’s portrait
of Lydgate’s clinical medical practices and actual nineteenth-
century clinicians’ medical records has helped shift critical
attention away from the Foucauldian disciplinary model back
toward the narrative’s efforts to present a moral example by
way of its depiction of the doctor’s intuitive sympathy for his
patients. Joseph Childers, Mary Poovey, and Lauren Goodlad
have considered the effects on principles of moral governance
of the Victorian development of statistics and other forms of
social science used to enhance the state’s efforts to observe
mass culture from a distanced perspective. Lorraine Daston
xiv P r eface
and George Levine both trace the development of what they

call scientific epistemologies in the Victorian period; Anderson
and Levine have connected this complex history to the devel-
opment of realism in the Victorian novel.
With only a few exceptions (Freedgood, Judd), however,
the scholarship that connects the narrative and rhetorical
strategies of social reform and medicine to the Victorian
novel, contextualizes the novels through examinations of the
writings of prominent male military, political, medical, and
philosophical figures, among them Edwin Chadwick, James
Kay-Shuttleworth, Thomas Chalmers, Adolphe Quetelet,
Auguste Comte, and John Stuart Mill. Despite ample doc-
umentation in correspondence of her close scholarly, profes-
sional, and friendly relationships with key figures in Victorian
sanitary reform, medicine, the War Office, Poor Law work-
house reform, viceroys to India, and other areas of social
policy reform, Nightingale’s philosophical, political, and so-
cial thought is only now getting the more thorough expo-
sure it deserves in McDonald’s Collected Works of Florence
Nightingale.
Though she never held public office, Nightingale, like the
novelists Dickens, Gaskell, Eliot, and to a lesser extent, Stretton,
had gained a significant measure of public moral authority for
her representations of social reform ideals. One need only look
at the moral authority Al Gore has acquired since leaving pres-
idential politics by focusing his environmental work on broad,
popular appeals in narrative (documentary) form to see that
a public figure may express his or her views more effectively
outside of government than in it. Unlike Gore, and prominent
nineteenth-century male intellectual and political figures,
of course, these female reformers had to negotiate complex,
gendered Victorian expectations about female narrative and
moral authority.10
To begin my story of how Nightingale and the novelists
influenced each other’s narrative and rhetorical strategies, let
me turn to an early, wonderfully detailed letter from Gaskell
to a friend describing Nightingale. In October of 1854, in
the midst of the cholera epidemic, she wrote from Lea Hurst,
P r eface xv
the Nightingale family home, just prior to Nightingale’s de-

parture for the Crimea and just after John Snow had begun
publishing his accounts of cholera as a water-borne infectious
disease.11 Gaskell takes as a fact, on Nightingale’s “last au-
thority,” that Cholera, which has just caused the death of a
mutual friend, is “not infectious i.e. does not pass from one
person to another.”12 Gaskell then attempts to convince her
friend of Nightingale’s view, not by providing any evidence
drawn from microscopical observations or statistical tables—
the two types of evidence mid-Victorian medical researchers
and social reformers most often drew from in their scien-
tific and policy disputes about the nature of disease ori-
gins and transmission. Instead Gaskell relays to her friend
Nightingale’s own story,
Miss Florence Nightingale, who went on the 31st of August to

take superintendence of the Cholera patients in the Middlesex
Hospital (where they were obliged to send out their usual
patients to take in the patients brought every half hour from
the Soho district, Broad St. especially,) says that only two
nurses had it, one of whom died, the other recovered; that
none of the porters &c had it, she herself was up day & night
from Friday [Sept 1] afternoon to Sunday afternoon, receiv-
ing the poor prostitutes, as they came in, (they had it worst
& were brought in from their “beat” along Oxford St—all
through the Friday night,) undressing them—& awfully
filthy they were, & putting on turpentine stupes &c all herself
to as many as she could manage—never had a touch even of
diarrhea.
Gaskell’s nearly breathless rehearsal of Nightingale’s vividly

detailed story, whether she heard it first from Nightingale or
someone else,13 manages to make two fascinating cases to her
friend: first, that cholera is not infectious and second, that
Nightingale herself is both a self-sacrificing heroine in setting
an example of proper care to others, and an ideal participant-
observer, capable of remembering significant details, relevant
to the crucial issue of disease transmission.
xvi P r eface
Gaskell quickly moves from the subject of disease to her

own observations of Nightingale:
“Oh! Katie I wish you could see her[.] She is tall; very slight &
willowy in figure; thick shortish rich brown hair[,] very delicate
pretty complexion, rather like Florence’s [Gaskell’s daughter],
only more delicate colouring, grey eyes which are generally
pensive & drooping, but when they choose can be the mer-
riest eyes I ever saw; and perfect teeth making her smile the
sweetest I ever saw. Put a long piece of soft net—say 1 ½ yd
half long, & ½ yd wide, and tie it round this beautiful shaped
head, so as to form a soft white frame-work for the full oval
of her face—[drawing] (for she had the toothache, & so wore
this little piece of drapery) and dress her up in black glace silk
up to the long round white throat—and a black shawl on—&
you may get near an idea of her perfect grace & lovely appear-
ance. She is like a saint. . . . And now she is the head of the
Establishment for invalid gentlewomen; nursing continually,
& present at every operation.”
Gaskell asks her friend to imagine an idealized portrait of

Nightingale, describing her in prose overflowing with hyper-
boles about her disposition and beauty (her eyes the “merri-
est,” her smile the “sweetest,” her teeth and grace “perfect”).
But Gaskell’s letter also reveals a Nightingale rarely seen in
the secondary literature, a playful, witty young woman, who
suffers from toothaches like everyone else and who, at this
point, had not yet learned to represent her poor patients in
ways calculated to raise the sympathies of her audience. In the
description, Gaskell reveals something of her own skill as a
participant-observer:
She has a great deal of fun, and is carried along by that I think.
She mimics most capitally the way of talking of some of the
poor governesses in the establishment, with their delight at
having a man servant and at having Lady Canning & Lady
Monteagle do this and that for them. And then at this Cholera
time she went off—leaving word where she could be sent for;
for she considered her ‘gentlewomen’ to have a prior claim on
P r eface xvii
her services—to the Middlesex Hospital &c! I came in here for

the end of her fortnight of holiday in the year. Is it not like St.
Elizabeth of Hungary? The efforts of her family to interest her
in other occupations by allowing her to travel &c.—but the
clinging to one object! Now I must go dress for dinner.14
Gaskell’s representation contains some of the reverence that

would dominate nineteenth-century portraits of Nightingale.
Later writings about Nightingale and nursing echo Gaskell’s
comparison to St. Elizabeth, a mother who built hospi-
tals, gave her fortune to the poor, and died young.15 But—
observant novelist that she was—Gaskell’s passage also
highlight Nightingale’s lively humor at her patients’ expense
and her (apparently, in Gaskell’s view) quaint, if not frivolous,
allegiance to her respectable, poor gentlewomen, for whom
Nightingale feels a “prior claim,” despite the urgency of her
other work superintending the cholera wards at the Middlesex
hospital during an outbreak of the deadly disease. Moreover,
in the same letter, Gaskell explains that Nightingale appears
to be “doing things by impulse—or some divine inspiration &
not by effort & struggle of will.” Gaskell’s complex response
to the pre-Crimean war Nightingale indicates both a desire to
see and strip the heroic from Nightingale’s image.
Gaskell’s letter begins the story of mutual influence, re-
spect, and competition between these prominent writers
that is the subject of this book. Gaskell’s confused effort to
represent Nightingale as somehow both an ideal and a real
woman reflects the same kinds of often competing impulses
toward exhaustive description and idealistic prescription that
Nightingale and the reformist novelists each worked to recon-
cile in their writing. Each addressed the ethical implications
of representing socially marginalized populations according to
her own scientific, philosophical, and moral understanding of
the world. Each recognized a similar concern in the others’
career and writings. And each writer’s evolving rhetorical and
narrative strategies reflect both the difficulty and importance
of that effort to her, and the enduring influence of the others’
engagement in the same struggle.
Ac k now l e dgm e n t s
I owe enormous thanks to many colleagues, friends, and fam-

ily members for helping me to complete Victorian Medicine
and Social Reform: Florence Nightingale among the Novelists.
To Helena Michie, Robert Patten, and Martin Wiener—my
“Dream Team” Ph.D. Advisors at Rice University—I owe
the development of my interest in the intersections between
Victorian literary, scientific, and medical cultures. I hope that
my work will always reflect their influence: I can think of no
better models of intellectual engagement and thoughtful men-
torship than those they provided for me. I owe Helena partic-
ular thanks for her steadfast encouragement and wise counsel
which have been invaluable to me. I feel incredibly lucky that,
as an undergraduate, I met Susan David Bernstein, my earliest
faculty advisor in literary research. I have benefited from her
wisdom and friendship throughout my academic career.
At Rice I met some amazing friends and scholars, who
have influenced and inspired me: Kay Heath, Janet Myers,
Dejan Kuzmanovic, Mary Zimmer, Antje Anderson, Marcia
Chamberlain, Martine Van Elk, Lloyd Kermode, Rebecca Stern,
Chuck Jackson, Eileen Cleere, Holly Cin, Apollo Amoko, Stephen
Da Silva, Carolyn White, Karen Lewis, Deborah Needleman-
Armi, Marshall Armintor, Ginny Lane, and others.
To Lois Rudnik, Pratima Prasad, Dejan Kuzmanovic, Mary
Zimmer, Kay Heath, Janet Myers, Woodruff Smith, Libby Fay,
Peter Taylor, Caroline Brown, Jenna Ivers, Megan Sullivan,
Tracy Slater, Sally Bould, and Malcom Smuts, my thanks for
their careful reading of material from this book.
At U Mass Boston, I owe thanks as well to all of my colleagues
and students for inspiring me daily and making my professional
life so often an absolute joy. Lois Rudnik was the most generous
xx Acknow ledgments
and best reader I could possibly have asked for. Her support at a
crucial time made all the difference. Cheryl Nixon, too, has been
an amazing friend and colleague whose support is invaluable to
me. Truthfully, I owe special thanks to all of my colleagues at
UMB. Each in their own way has offered me support from my
first day on campus to the present. To all of them my thanks for
great meals and conversations, some very bad jokes, and the odd
beer. Nearby at the University of New Hampshire, one of my
oldest friends, Piero Garofalo has helped me to see the humor
in a lot of hard work. At Transylvania University, I worked with
many fine colleagues and students, a number of whom have
remained dear friends: Ellen Cox, Kim Miller, Bryan Trabold,
Tay Fizdale, Sharon Brown, Kathleen Jagger, Peggy Palombi,
Alan Goren, Simonetta Cochis, Joël Dubois, and others.
Michael and Eveleigh Bradford in Leeds, and Adrian Gans,
David Houlker, and Iona Italia in London have made it im-
measurably easier and much more fun making research trips to
Britain. They and family members in Virginia, Leeds, Otley,
Nottingham, and Victoria, BC have supported me throughout.
To the librarians at the Bodleian Library, British Library, and
Wellcome library, and the University of Massachusetts, Boston,
particularly Janet Stewart, my thanks for their assistance in lo-
cating materials.
I and all future scholars of Nightingale owe an enormous
debt to Lynn McDonald, and those who have assisted her at the
Florence Nightingale project. These include of course Gerard
Vallée, who edited three of the projected sixteen volumes of
The Collected Works of Florence Nightingale. McDonald gener-
ously shared pre-publication materials from Volumes 10: Social
Reform in India and Volume 11: Suggestions for Thought, at
a pivotal point for me in the writing of this book. She also
showed immense generosity and kindness toward me during
a research trip I made to Toronto to consult with materials
in her incredible archive of Nightingale’s published and un-
published writing. Her intellectual rigor in collecting, editing,
and contextualizing Nightingale’s materials sets an impressive
standard for future scholarship on Nightingale.
I owe a special thanks to Marilyn Gaull for her steadfast sup-
port of this project and her generous guidance, not to mention
Acknow ledgments xxi
her keen editorial eye. To Farideh Koohi-Kamali for represent-

ing this book at Palgrave Macmillan, and to Bridgette Schull,
Lee Norton, Rachel Tekula, and Rohini Krishnan who have
also tended to it.
I would like to thank Wiley-Blackwell Publishing for per-
mission to reprint material that appeared in a different form
in my article “Medicine of the 1820s,” Literature Compass
1.1 (2004). My thanks are due as well to Rodopi for permis-
sion to reprint material that also appeared in a different form
in my essay “Florence Nightingale’s sensational Narrative of
Contamination and Contagion,” Making Sense of Health, Illness
and Disease, edited by Peter L. Twohig and Vera Kalitzkus,
Amsterdam and New York: Rodopi, 2004, 87–104.
Throughout writing this book, several friends have not only
helped me stay sane, but also helped to make my life incred-
ibly fun. Many of these friends I’ve already mentioned. To
all those who’ve camped, hiked, swam, skied, backpacked,
danced, biked, celebrated, and commiserated with me over
the years—Shelly, Randall, Patti, Bryan, Cindy, Ed, Rod, Kay,
Jackie, Wendy, Sue, Julia, Paul, Maria, Robyn, Bill, Robin,
Elizabeth, Tom, Tim, Page, John, Scott, the hiking “Ladies,”
and all my AMC and MetaMovements friends—I am more
grateful than I can say.
This book would never have been written without the
constant love and support of my family to whom Victorian
Medicine and Social Reform is dedicated. My brother-in-law,
Jamie, sister-in-law, Liz, my irrepressible nephews, Wesley and
Wilson, and my fantastic in-laws, the Hoppes, Boehlers, and
Burneses are a constant source of fun and support. My parents,
Rosemary and Terry Penner, read every word of the manuscript
and encouraged me through the long process of seeing the
project through to publication. I’ll never be able to thank them
enough for all the love and support that they’ve given me. The
same is true of my brother and sister, John and Jane. To them,
and particularly to my parents, I owe the beginnings of my in-
terest in Victorian literature and culture and the confidence to
make researching and teaching literature my profession.
While I have benefited from the generosity of so many, any
mistakes and oversights within this book are entirely mine.
I n t roduc t ion
The idealistic, thirty-one-year-old Florence Nightingale

whom Elizabeth Gaskell describes in her letter of October of
1854 (see preface) 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
known 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, eco-
nomic, and other social reforms; nonetheless, the spiritual, sci-
entific, 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 estab-
lished. 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 obser-
vation of phenomena in the world (the numbers of suicides,
of crime, of deaths by famine, etc.). After the relevant facts
had been gathered through observation, she claimed, the sci-
ence 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
2 Victor i a n Medicine a nd Soci a l R efor m
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, commu-
nity, and sympathy. While she clearly expected that observa-
tions 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, particularly the burgeoning inter-
est 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 (for many people central Christian doctrines),1 she
became in her public writings a long-time dogmatic opponent
of contagionism—the view that diseases were caused by invis-
ible 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 (in the interests of furthering her
cause), Nightingale always viewed her arguments about poli-
tics, 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.
Introduction 3
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 ide-
als and methods following her return from the Crimea.2 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.
Nightingale’s considerable moral authority in Britain came
first from the perception of her as a ministering angel in the
Crimea. Among many in the reformist and literary commu-
nities, such as Gaskell and Harriet Martineau (both of whom
admired her activism even prior to her work in the Crimea),
Nightingale’s reputation and authority was also related to her
abilities as a participant observer.3 Where early works such as
Sketches by Boz and Oliver Twist, had gained Dickens author-
ity as an observer and satirist of social problems in London,
Nightingale’s much more limited reputation prior to her
departure from the Crimea was built, not just on her self-
sacrifice (foregoing marriage and leisure in the interests of her
“calling” from God to serve the less fortunate), but also on
her efficiency, compassion, and skill as an observer and partic-
ipant in the lives of those whom she tended at Harley Street.
Following her return from Scutari and the Crimea, having
first gone through the fires of administrative and logistical
frustration and learned the value of attempts to deal with
these through behind-the-scenes negotiations with those in
power, Nightingale saw her potential to use the experiential
and moral authority she had gained from directing nursing in
her hospital in Scutari to try to influence a wider audience in
the direction of adopting sanitary science as a kind of moral

imperative.
While she did make attempts at writing fiction early in her
life, about which I will have more to say in chapter 3, after her
return from the Crimea Nightingale’s public writing consisted
primarily of essays that she published in journals with wide
circulations, and books written either for government officials
or to appeal to a broad population. The kinds of narratives
about social problems that were getting and keeping the public
attention, both fictional and nonfictional, tended to be ones
that—like our police dramas today—were (or claimed to be)
“ripped from the headlines.” As Mark Bostridge notes in his
biography of Nightingale, William Howard Russell’s report-
ing from the Crimea, the same reporting that in part inspired
Nightingale’s desire to go to the Crimea, “launched a new
era of war reportage, and of the mobilization of middle-class
opinion to generate reform” (Bostridge, 203).
Nightingale’s early awareness of the potential power of her
writing to influence public beliefs and behaviors using rhe-
torical and narrative strategies similar to popular novels is
the subject of chapter 1. When Nightingale wrote her first
attempts to reach a broad readership in Notes on Hospitals and
Notes on Nursing, she showed the practical side of her reform-
ist impulses by curbing her dogmatic anti-contagionism and
exploiting fears of contagion. The sensationalist impulse of
Notes on Nursing resonates powerfully with the narrative strat-
egies of sensation novelists, who set in motion wildly popu-
lar trends in dress, behavior, and popular belief. The anxious
debate about disease origins and means of transmission cir-
culating within the mid-century administrative, medical, and
sanitary reformist circles fuels the narrative within striking
scenes in both Nightingale’s Notes on Nursing and Wilkie
Collins’s The Woman in White.
After the popular success of the two books on hospitals and
nursing, the focus of Nightingale’s public and private writings
adjusted in the 1860s and early 1870s to give more attention
to the issues of Poor Law reform and sanitary reform in the
British army in India. Chapter 2 “On Giving: Work, Family,
Introduction 5
and Poor Law Reform in Nightingale, Dickens, and Stretton,”

focuses on Nightingale’s writings about the domestic problems
of poverty, overpopulation, poor sanitation, and the like that
plagued urban areas. Nightingale’s public and private writings
on these issues, particularly those related to philanthropic and
governmental efforts to alleviate poverty, reflect her evolv-
ing sense of her audience and of her own moral authority on
the issues. The chapter begins by surveying briefly the critical
responses to Nightingale’s 1860s writings Notes on Nursing
and Notes on Hospitals and proceeds into an analysis of the ide-
als that grounded Nightingale’s Poor Law writings. Evident
within this work is Nightingale’s awareness of the impact of
her own story on the public’s ideas about reform and the sub-
stantial care she took to participate in philanthropic and re-
formist work in ways that would not encourage self-serving
imitators. This chapter considers Nightingale’s Poor Law writ-
ings alongside representative examples of reformist fiction by
Dickens and the then-popular novelist Hesba Stretton, works
which Nightingale read and donated to the nurses, soldiers,
and the various charities to which she gave her own work. The
comparative analysis reveals much about the painstaking care
that Nightingale took in attempting to sway her readers in
government and in the general public to her views of philan-
thropy and reform.
Chapter 3, “Competing Visions: Nightingale, Eliot, and
Victorian Health Reform,” explores in detail Nightingale’s
response to the social and moral authority being granted in
Victorian intellectual circles to George Eliot, particularly after
the publication of Eliot’s masterpiece of Victorian realism,
Middlemarch (1871–1872). Well aware, as earlier chapters es-
tablish, of the power of fiction to influence the views of the
public on scientific, medical, and reformist issues, Nightingale
reacted with virulent distaste to Middlemarch, despite having
admired greatly earlier novels by Eliot, particularly Romola.
This chapter suggests that Nightingale’s excessive response to
Middlemarch reflects more than just her acknowledged dis-
appointment with the fate of the novel’s heroine Dorothea
Ladislaw, who can find no greater outlet for her reformist
impulses than marriage to an aspiring, idealist Middlemarch

politician.4 The strength of Nightingale’s reaction reflects
what she must have seen as the potentially damaging effect
that Eliot’s status as expert in a new kind of scientifically, soc-
iologically, and medically informed realism might have not
only on Nightingale’s own authority as expert in these fields,
but perhaps more importantly also on the public perception of
issues that were fundamental to her belief system. These issues
included especially her firmly held belief that sanitary science
provided evidence of God’s benevolent plan that moves hum-
anity in the direction of higher and better types of being.
Nightingale’s attentions in the 1870s were divided pri-
marily between the issues of sanitation and Poor Law reform
in Britain, and her concerns about British administration in
India. While that concern began as an interest in the sanitary
conditions of the British army in India, the vast amounts of
data she collected on those conditions, coupled with the horri-
fying statistics about numbers of dead in India due to famines,
soon revealed to her other more pressing and difficult issues
with regard to British governance in India that she felt she
needed to bring to the attention of the British public. In several
letters of 1879 Nightingale expressed her desire for an “Indian
Dickens” to tell the story of Indian peasants’ suffering under
the colonial government’s irrigation and land tenancy policies.5
She clearly recognized that the lingering anxieties raised by the
1857 Sepoy Mutiny and the subsequent peasant uprisings made
raising British sympathies for the millions of starving peasants
in India difficult. The strategy she arrived at to combat British
apathy was to see that the stories of individual peasants be told
in the must affecting manner possible. She wished, essentially,
to raise British popular sympathies for the Indian peasant (or
Ryot as peasants were called) the way Dickens had done forty
years earlier for the workhouse boy in Oliver Twist and the
prostitute in Sketches by Boz and Oliver Twist.
Rather than adopting Dickens’s detached or “distanced”
narrative style, however, Nightingale adopts a narrative voice
that bears direct comparison with that of Elizabeth Gaskell’s
more “engaging” narrator in Mary Barton, one who presents
Introduction 7
herself as a sympathetic and knowledgeable, but also a humble

participant observer, herself in awe of the heroism she witnesses
in the population she represents. She uses these examples of
heroism, hard work, and honesty in tandem with providing
information about Indian religious beliefs (both Hindu and
Muslim) to combat the perception of native Indian peasants
as a heathen mob.6 While establishing links between the nar-
rative strategies of Nightingale and Gaskell, this chapter also
notes important differences between Nightingale’s portrait
of heroic Ryots and the depictions of Indian behavior con-
tained in Victorian travel narratives of British visitors to India.
I describe Nightingale’s effective adjustment of her narrative
techniques in response to the difficult task of arousing British
attentions to a population whose sheer numbers and differ-
ences in belief systems made them unsympathetic to a British
public increasingly anxious about the fate of their empire.
The Epilogue considers briefly Florence Nightingale’s legacy
in literary depictions of her and in the sociological impulse in
reformist fiction. It addresses as well contemporary reactions
to the many worthy attempts that have been made in recent
years to rehabilitate interest in Nightingale, this time not
simply as the heroine of the Crimea, but as a rigorous scholar
who investigated tirelessly the roots of the social problems of
her time, and a masterful behind-the-scenes reformer. That so
much of the current population who are familiar with Florence
Nightingale’s name know nothing of the influence she had on
health and social policy of her day seems a terrible oversight.
Thanks to the Herculean efforts of Lynn McDonald and
the Florence Nightingale Project she established, there is now
an immense amount of Nightingale’s public and private writ-
ings available in print and electronic text formats, many of
which were previously unpublished and scattered in archives
throughout the world. Reading Nightingale’s private corre-
spondence alongside her public essays reveals a brilliant mind
at work negotiating her own public image and the potential
influence that her work, her writing, and her story might have
on others.
Chapter 1
D e f e n di ng Hom e a n d C ou n t ry :
Fl or e nc e Nigh t i ng a l e’s Tr a i n i ng
of Dom est ic Det ec t i v es
In Victorian Writing about Risk (2000), Elaine Freedgood

claims that the anti-contagionist theories of Florence
Nightingale, Edwin Chadwick, and other sanitary reformers
of the early Victorian period helped to calm England’s fears
about epidemic disease after deadly outbreaks of cholera and
typhoid had put the nation into a state of near panic. Anti-
contagionist theory eased anxieties about industrial and impe-
rial progress—medical experts and the press having blamed
British expansion in these areas for the epidemics of the early
part of the century (Freedgood, 42).
Briefly put, anti-contagionism was the theory that diseases
were caused by sustained exposure to environmental filth and
contamination. The theory countered two kinds of contagion
theories (1) arguments for the metaphysical origin of dis-
ease as God’s means of punishment for humans’ sins (moral
contagion); and (2) theories of physical contagion occurring
between bodies and body products in the form of as yet un-
observed germs and viruses, possibly even by means of a single
exposure. Through careful observation and accumulations of
statistics about the environment, sanitary factors could thus
be observed and used to predict and prevent outbreaks of dis-
ease. Throughout this chapter, I use the term “contamination”
when referring to disease transmission explained as resulting

exclusively from long-term exposure to environmental or mi-
asmatic causes, while I reserve the term “physical contagion”
for references to disease transmission explained as occurring
possibly even through a single contact between bodies. As one
who took a strict empiricist position in many of her writings,
Nightingale insisted on extruding all reference to supposed
unobservables. Rather than operating from theories, she felt
sanitary factors could be observed and used to predict and
prevent outbreaks of disease.
Freedgood sees Chadwick’s and Nightingale’s many works
on sanitation and public policy, particularly his Report on
the Sanitary Condition of the Working Classes (1842) and her
Notes on Nursing (1860) and Notes on Hospitals (1859), with
their marshalling of statistics in support of sanitary arguments
as being “the non-literary counterpart of the confident and
ambitious inclusiveness of the realist novel” (46)—the most
significant difference between the two types of texts being
that Chadwick and Nightingale address social problems and
then immediately offer effective cures, while the realist novel
restricts itself to allowing the reader to both “experience and
endure” the social problem “over time” and, in her words, “at
a safe distance” (47).
In contrast to the relatively comforting distance and time
offered to the reader of the realist novel, Freedgood suggests
that Nightingale and Chadwick raise the specter of diseases
caused by particular sanitary problems and then offer “short-
acting” cures for those specific problems (e.g., rooms without
ventilation, dirty linen), that will solve them, while at the same
time creating longer-term anxieties about sanitary matters
more generally.1 Where disease is present in a region, a home,
or even a nation, Nightingale and Chadwick find a source for
that disease in unclean drapes, streets, sheets, etc. and “prove”
via statistics that addressing the problem in the way that
they suggest will indeed take care of it. Thus for Freedgood,
Nightingale’s and Chadwick’s sanitary tracts raise each threat
in such quick succession and offer solutions so immediately
after raising them that their texts ultimately produce in their
Defending Home a nd Country 11
readers a heightened concern about sanitation and an increased

valuing of detached observation of sanitary factors.
Freedgood’s distinction between the rhetorical treatments
of the sanitary threat in the realist novel and the statistical
report offers an intriguing point of departure for interpret-
ing Nightingale’s writings about disease, which can appear
contradictory in their goals and in their positions on disease
theory. This is particularly evident when a reader places her
Notes on Hospitals side-by-side with her Notes on Nursing:
What It Is and What It Is Not. She wrote Notes on Hospitals
for government bureaucrats with an eye to influencing long-
term social policies not only in hospitals but in other institu-
tions such as the army. She wrote Notes on Nursing initially
for middle-class women with an eye to short-term solutions to
sanitary problems in the home, and to encourage longer-term
sanitary practices there. While Chadwick’s Report argues for
a Central Board of Health to oversee the health of the nation
and Nightingale’s Notes on Hospitals argues for better sanitary
engineering and management in hospitals, Notes on Nursing
focuses on the domestic sphere and sanitary household man-
agement. While similar in philosophical basis and in the san-
itary practices they ultimately encourage, Notes on Hospitals
and Notes on Nursing make vastly different kinds of rhetor-
ical appeals to their readers and they may seem to embrace
different views on the disease theory question. While Notes
on Hospitals unequivocally rejects any version of contagion
theory, Notes on Nursing avoids explicitly countering conta-
gion theory anywhere but in footnotes and it may even seem
implicitly to endorse the notion of physical contagion.
The rhetorical differences between Nightingale’s two texts
are indicative of Nightingale’s willingness, particularly when
addressing women, to exploit the fears that her texts were os-
tensibly written to alleviate. Freedgood’s account of the dual
function of the “short-acting” measures Nightingale offers—
they provide both a cure for a particular sanitary problem and
a way of elevating her reader’s anxiety about that problem—
raises an interesting comparison between Nightingale’s rhetoric
and the narrative logic of the sensation novel, an immensely
popular variant of the Victorian realist novel, which emerged

in the 1860s in England. The detective plots of sensation nov-
els often borrowed their plots from “real” tabloid accounts of
murderesses, bigamists, and adulterers to expose and drama-
tize social problems, particularly problems related to women’s
active, but often covert, rebellion against the strictures placed
on their lives mostly by men. Such accounts shocked readers
by contradicting cultural assumptions about women’s passive
nature and behavior. Like Nightingale’s Notes on Nursing and
Notes on Hospitals, the primary narrative voices in many of
these novels endorse a model of detached empiricist obser-
vation and detection to expose and ultimately contain social
problems.
But the focus of the sensation novel is also, as its critics
lamented, to provoke physical reactions in the reader as he or
she “experienced” the novel’s exposing of the problem. The
novels’ contemporary critics attacked them for provoking a
sensational reaction in the reader, by startling the reader with,
for instance, an account of the sudden appearance of a hand
out of the darkness, or by shocking the reader with the sug-
gestion of insidious forces acting unbeknownst to the observ-
ing narrator. Sensation fiction exploded in popularity at about
the same time that Nightingale was writing Notes on Nursing
and publishing a third edition of Notes on Hospitals. And crit-
ics accused its authors of exploiting fears about women’s desire
for independence and social authority and of preying on wom-
en’s natural delicacy, agitating her to near-hysteria.2
Nightingale certainly meant for her prescriptions for house-
hold management to assure readers of the English woman’s
particular ability to ward off the potential for diseases to invade
the home, but only if the English woman was well trained in
methods of detached observation. Nightingale probably knew,
however, that she was facing a new era in thinking about dis-
ease. The 1860s was the period in which germ theories of
disease were beginning to emerge, and though not yet uni-
versally accepted or even largely influential, Nightingale knew
early germ theory would be likely to produce panic about epi-
demic disease outbreak after the initial confidence inspired by
the statistical, anti-contagionist health reports of the 1840s

had initially calmed such fears. If contagion theories were
true, then the overpopulation of industrial cities would cause
heightened concern about the potential for rapid spread of dis-
ease and the expansion of England’s colonial efforts in India,
Africa, and other regions would make the nation as a whole
more vulnerable to outbreaks of epidemics. Nightingale prob-
ably saw the advantages of exploiting fears of contagion, but
wanted to do so in such a way that she would actually pro-
mote household management designed on anti-contagionist
principles.
I contrast Nightingale’s rhetoric in Notes on Hospitals
with her rhetoric in Notes on Nursing to trace the ways that
Nightingale exploits fear of contagion in Notes on Nursing.
Here she uses a narrative structure and style quite similar to
that of sensation fiction novels in order to discipline her reader
into compliance with her sanitary guidelines for home man-
agement. To support this claim, I describe Nightingale’s own
sense of the power of the novel to influence public feeling
and her despair about their lack of useful moral and prac-
tical messages3; I then turn to Nightingale’s efforts to con-
vince her reader to follow her anti-contagionist strictures for
hospital and household management. When addressing hos-
pitals’ conditions, Nightingale focuses on the health of the
nation—all national subjects are potential patients, subject to
poor sanitation guidelines in government and in hospitals; but
when focusing her clinical gaze on the home, the mental and
physical health of the household manager is also at stake in
Nightingale’s narrative. The household manager must be able
to imitate Nightingale’s model of detached, empirical obser-
vation without the influence of metaphysical presuppositions
about disease. Finally, to illustrate the effects of the sensational
sanitary rhetoric Nightingale and other sanitarians increas-
ingly leveled at middle-class household managers, I connect
Nightingale’s rhetoric in her advice to women in Notes on
Nursing to the narrative voice of Walter Hartright, the embat-
tled “editor” and primary narrator of Wilkie Collins’s sensa-
tion fiction novel, The Woman in White (1860), published the
same year as Notes on Nursing and Nightingale’s third edition

of Notes on Hospitals.
Combining Fact and Fiction for

the Sake of Argument
That Nightingale knew of the popularity and potential influ-
ence of sensation fiction and worried about its potential effects
on the public is evident in her unpublished writings. In her
prolific annotations to her friend Benjamin Jowett’s transla-
tions of Plato’s dialogues, for example, Nightingale comments
extensively on a particular section of Jowett’s introduction to
The Republic, in which Jowett describes Plato’s critique of the
poets of his day. Her annotations repeatedly articulate her view
that novelists in her day are the equivalent of the poets that
Plato and Socrates attacked in their era for inspiring unhealthy
emotion in their readers and audience members. For example,
Nightingale clearly paused at the following passage in Jowett’s
introduction to The Republic: “The poets, as [Plato] says in
the Protagoras, are the Sophists of their day—new foes under
an old face. They are regarded by him chiefly in one point of
view, as the enemies of reason and abstraction” (Jowett, Intro.
to The Republic, 131–32). In the margins next to this para-
graph Nightingale writes, “So are Novelists, the real Art of
the day, the Sophists of this day: Balzac and Miss Braddon.”4
Nightingale’s comparison of the Sophists of Plato’s day to two
novelists of her own period, particularly two who were so fre-
quently associated with intense expression of feeling, indicates
her concern with the powerful, but often negative influence
novelists might have over a wide audience precisely because of
their ability to provoke feeling. Balzac’s sentimental, realist nov-
els, such as Père Goriot and Le Colonal Chabert and Braddon’s
Lady Audley’s Secret, Aurora Floyd, and The Doctor’s Wife, to
name a few, might seem a far cry from Greek poetry and phi-
losophy, but the comparison is intriguing. The Sophists were
itinerant teachers of rhetoric—teachers of the ways to “success”
in life—whom Socrates accuses in The Apology and elsewhere
of caring not for the truth of their argument, but for winning
the argument with flashy, rather than substantive, rhetoric.

Socrates criticizes the Sophists too for accepting money for
their lessons, thus further compromising the integrity of their
truth claims. Nightingale’s comparison indicates her aware-
ness of the great potential that sensational and sentimental
literature had for influencing the public and for exploiting the
audience for personal gain.
Though she bemoans the potential influence that popular
novels have on readers, she does not suggest that the power
of fiction to inspire emotion is in itself a bad thing. In fact,
she seems to see potential for good in exploiting such power.
She pauses again over a passage in Jowett’s introduction about
the potential usefulness of art in its ability to inspire human
emotion:
For the emotions are neither bad nor good in themselves, and
are not most likely to be controlled by the attempt to eradi-
cate them, but by the moderate indulgence of them. And the
vocation of art is to present thought in the form of feeling,
to enlist the feelings on the side of reason, to inspire even for
a moment courage or resignation; perhaps to suggest a sense
of infinity and eternity in a way which mere language is inca-
pable of attaining. True, the power which in the purer age of
art embodies Gods and heroes only, may be made to express
the voluptuous image of a Corinthian courtesan. But this only
shows that art like other outward things, may be turned to
good and also to evil and is not more closely connected with
the lower than with the higher part of the soul. (Jowett, Intro.
to The Republic, 132)
Nightingale’s annotations to this paragraph indicate her

agreement with the first part of this passage in which Jowett
describes the power of art to enlist feelings on the side of
reason. But at the point where Jowett suggests that art can
inspire “a sense of infinity and eternity” in a way that mere
language cannot, she questions in the margins “But how does
it?” And she appears to object particularly to Jowett’s sugges-
tion that the image of the Corinthian courtesan is an inappro-
priate subject for art, while the legends of Gods and heroes
will surely inspire readers to heroism. She writes in the margin,

“You are as bad as Plato: because the present Religious novel is
the worst of all, you would have none.” The subjects of art and
the traditional modes of inspiring heroism that Jowett seems
unquestioningly to endorse appear to fall flat with her.
These annotations appear to me to reflect a wish to envi-
sion new modes of heroism that might be available particularly
to her female contemporaries.5 They suggest that Nightingale
recognized the practical value of utilizing the techniques of
popular fiction to help get at a larger reading public than her
previous sanitary writing, Notes on Hospitals, had reached. Her
annotations thus inspire me to read Notes on Nursing as hav-
ing two intended effects, both dependent on the success of her
ability to elicit from her readers a sense of the gravity of the
household manager’s role in defending the house from disease.
First, she wants to shock her readers into sanitary vigilance;
and second, she wants to inspire her female readers to see their
household management as heroic work, but only if they use
neutral, empiricist observation to perform that work correctly.
Ironically, to inspire the alarm necessary to achieve her two
goals Nightingale must, in Notes on Nursing, have felt she was
adopting rhetorical strategies reminiscent of the “Sophists of
[her] day.” She risks replicating the fault Plato sees in poetry of
“paint[ing] an inferior degree of truth,” “concern[ing] [one-
self] with an inferior part of the soul” and “indulg[ing] the
feelings, while . . . enfeeble[ing] the reason” (Jowett, Intro. to
The Republic, 122).
Capturing the Reader’s Imagination:

Bodies, Infection, and Narrative
Looked at together, Nightingale’s first attempts to reach a
broader audience through writing, Notes on Hospitals and Notes
on Nursing, suggest that she at least initially felt confident that
she could reach her desired audiences and offer solutions to
disease problems facing the nation, the domestic sphere, and
the individual. But she presents her views of disease causes and
means of transmission differently in the two texts, a difference
that suggests her awareness of the importance of tailoring her

rhetorical strategies in response to her perception of the views
of her intended readership. Nightingale’s rhetoric in Notes on
Hospitals is explicitly anti-contagionist. Here, Nightingale
concludes that the theory of contagion was a fiction created
for social and political ends. She writes,
The idea of “contagion,” as explaining the spread of disease,

appears to have been adopted at a time when, from the neglect
of sanitary arrangements, epidemics attacked whole masses of
people, and when men had ceased to consider that nature had
any laws for her guidance. Beginning with the poets and histo-
rians, the word finally made its way into medical nomenclature
where it has remained ever since, affording to certain classes
of minds, chiefly in the Southern and less educated parts of
Europe, a satisfactory reason for pestilence, and an adequate
excuse for non-exertion to prevent its recurrence. (9)
Leaving aside for a moment the ideological problems evident

in Nightingale’s derogatory remarks on “the Southern and less
educated parts of Europe,” I want to focus on the impression
Nightingale gives here of rejecting contagion theory on two
grounds: First, according to the logic she invokes here, only
those who rely on observation and statistical analysis to verify
the laws of nature, can perceive the so-called facts of disease.
In other words, by locating what David Hume would call, the
“constant conjunction” of particular observable environmen-
tal factors and disease, one can establish laws to explain the
causes and spread of disease.6 Our willful ignorance of those
laws, she argues, makes us responsible for the diseases and ill
health that result from it. In her words:
God lays down certain physical laws. Upon His carrying out
such laws depends our responsibility (that much abused word),
for how could we have any responsibility for actions, the results
of which we could not foresee—which would be the case if the
carrying out of His laws were not certain. Yet we seem to be
continually expecting that He will work a miracle—i.e. break
His own laws expressly to relieve us of responsibility. (Notes on

Nursing, 25)
The reference to the impossibility of God “break[ing] His

own laws,” indicates her rejection of the idea that God strikes
down individuals or communities by introducing contagious
diseases as divine punishment for misdeeds (moral contagion).
Instead, God sets up nature according to laws, which can be
revealed through observation, and the clever nurse will act
according to them.
The second ground on which she bases her rejection of con-
tagion in the passage above is her claim that belief in contagion
itself derives from storytelling. Thus the language of contagion
has itself infected both the medical and popular perceptions
of disease, misleading the general public about disease causes
and allowing for the public’s indifference to issues of sanita-
tion and hygiene. She places the onus for such neglect on the
theories of “the Southern and less educated parts of Europe.”
She may have intended her argument to be a radical empiricist
rejection of anything departing from Humean canons, but she
may also have intended it to manipulate the disease question
into one that can be swayed by the language of national pride
and the government’s benevolent paternalism.
Nightingale’s rejection of contagion in Notes on Hospitals
and her anxiety about the infectious potential of even the
language of contagion indicate that at least when addressing
government and hospital officials, fighting belief in contagion
was a prime concern to her. She leaves no possible avenue for
endorsing theories of contagion here.
But when Nightingale turns to addressing middle-class
women in Notes on Nursing, she relies on provoking anxiety
in her reader about the threat of disease by focusing on sick
bodies and the products of these sick bodies to the extent that
the text seems almost to force the reader to obsess about the
possibility of physical contagion.
Granted, Nightingale appears to have wanted Notes on
Nursing to be a means for her to transfer her own knowledge
about hygiene to primarily middle-class women.7 But she does
not use the essay explicitly as a platform from which to make

the anti-contagionist argument she makes so strongly in Notes
on Hospitals. Her advice is geared toward promoting house-
hold management according to her anti-contagionist beliefs,
but her rhetoric inspires women to act by leaving the possi-
bility of contagion intact, and even perhaps encouraging her
readers’ fears about contagion.
Her account of the average, dirty, middle-class home pres-
ents a call for strict rules of hygiene and intolerance of lazi-
ness similar to that contained in her critique of the “Southern
Europeans.” Where this narrative differs substantially from
Notes on Hospitals, however, is in her own obsession with the
body’s products and their effects on the environment. She
often identifies the source of contamination within the home
as the products of the sick patient’s body, including the breath,
sweat, and hair. She argues, for instance, against keeping the
sickroom air warm by keeping windows closed and “making
the sick repeatedly breathe their own hot, humid, putrescing
atmosphere,” an action that will serve only, she says, “to delay
recovery or to destroy life” (Notes on Nursing, 16). Elsewhere,
she claims that:
Of all the methods of keeping patients warm the very worst is

certainly to depend for heat on the breath and bodies of the
sick. I have known a medical officer keep his ward windows
hermetically closed, thus exposing the sick to all the dangers
of infected atmospheres, because he was afraid that, by admit-
ting fresh air the temperature of the ward would be too much
lowered. This is a destructive fallacy. (Notes on Nursing, 15)
The logic of these claims may be evident to a twenty-first cen-

tury reader (no-one who could afford not to would choose to
reside in a room in which “the breath and bodies of the sick”
were the methods of providing heat), but her claims would
have appeared to nineteenth-century anti-contagionists as
coming dangerously close to endorsing contagion theory. Her
explanation of environmental contaminants even extends to
rooms left closed up after the human inhabitants have left. She
writes, “Old papered walls of years’ standing, dirty carpets,

uncleansed furniture, are just as ready sources of impurity to
the air as if there were a dung-heap in the basement” (Notes
on Nursing, 27). Even the sink is personified to add dramatic
effect to her claim that “The ordinary sink is an abomination.
That great surface of stone, which is always left wet, is always
exhaling into the air” (26). Such passages may well seem to
suggest that Nightingale is allowing for the possibility of single
contact contagion. On the other hand, it may have been to
save herself from the charge of inconsistency from those who
knew her views on constant contact with a contaminating en-
vironment that Nightingale is careful to talk of “repeatedly”
breathing bad air and the sink “always” exhaling into the air.
Nightingale’s narrative thus raises scientific and narrato-
logical questions about the status of the body in narratives
of contagion and contamination. Does the body, or do the
products of the body, infect the environment? Is there a fear
that perhaps talk of the body will suggest single-contact con-
tagion? Does disease originate in the environment? Is it the
case that, as Nightingale argues in Notes on Hospitals and else-
where, the environment is the only force that influences dis-
ease? Why does Nightingale seem to invite discussion of the
body in one text, while seeming to eschew it in the other? In
her own insistence on the need for the clean home and body,
Nightingale provides a description of the relationship between
the body and the environment that is body phobic to the point
of providing evidence of single-contact contagion.
In Notes on Nursing Nightingale does not address the diffi-
cult scientific question of whether or not bodies or the prod-
ucts of bodies can infect the environment (perhaps even via a
single contact) or whether they are indeed part of the environ-
ment. One could argue that this question was just too techni-
cal and complex for her to take it up in a text more interested
in prescribing behavior to women than actually educating
women in the scientific bases that underlie those prescriptions.
After all, medical professionals with whom Nightingale corre-
sponded struggled too with this question. Thomas Southwood
Smith, for example, tried in 1829 to claim a middle ground
between the contagion and environment positions by using

the term “infection” to describe the transmission of disease
through breathing air infected by the breath of a sick per-
son. Southwood Smith uses the term “infection” in a neutral
way, rather than strictly attributing the spread of disease to
either environmental pollutants or contagion through physi-
cal contact.8 In Notes on Hospitals, Nightingale, objecting to
just such means of fence-sitting, responded with a clear state-
ment denying that the term “infection” provided any room
for belief in contagion. She argued, “The word ‘infection,’
which is often confounded with ‘contagion,’ expresses a fact,
and does not involve a hypothesis. But just as there is no
such thing as ‘contagion,’ there is no such thing as inevita-
ble ‘infection.’ Infection acts through the air. Poison the air
breathed by individuals, and there is infection” (Nightingale’s
emphasis).9 While Nightingale objects to the conflation of the
terms infection and contagion, even here she offers no account
of when or how body products become products of environ-
mental contamination, rather than agents of contagion.
The recent cholera epidemic in London (1854–1856) will
have made the relationship between environmental contami-
nants and body products a particularly troubling one for
Nightingale to confront. John Snow’s studies of the London
cholera outbreak produced his cholera map of St James’s,
published in the second edition of his On the Mode of the
Communication of Cholera (1855). By indicating where each
case of cholera appeared and highlighting those locations’
proximity to the Broad Street Well, the map illustrated his
hypothesis that cholera was being spread via fecal-oral trans-
mission, as residents drank contaminated water supplies from
the well. Snow’s theory led to the spectacular removal of the
well handle. Snow inferred from his theory two cause-effect
relationships: first, he assumed that even a brief, rather than
prolonged, contact with infected water might lead to dis-
ease; and second, he inferred that he could connect a par-
ticular “germ” to a particular disease. As Pamela K. Gilbert,
Margaret Pelling, and others have noted, Snow’s map was
“a highly selective illustration of a hypothesis, not a research
tool” (Gilbert, 62). It was, nevertheless, influential enough

that, despite the Royal College of Physicians having rejected
Snow’s theory prior to the publication of the second edition of
On the Mode, the 1856 report of the General Board of Health,
written by John Simon, admitted that despite their conclu-
sion that not all cases of cholera could be explained by Snow’s
hypothesis, some could only be explained by it.
Nightingale’s fury at Simon’s support of contagion theories
in his 1856 report, as well as in another report he wrote for
the board in 1858, is evident from her private correspondence
of 1858. Writing to Lord Stanley, she says,
Mr. Simon’s work has always been what may fairly be called
“scampish,” in the language of the trades; his writings must
always be considered as the result of a “prospecting” expedi-
tion, as they call it in the gold countries. The last report of
the board of health, to which I have alluded, and the report
on Netley Hospital are indications of this. “All sanitary pre-
cautions are to be undervalued” because they have become
unpopular; “epidemics to be declared inevitable” and “quar-
antine to be substituted for sanitary improvement”—quaran-
tine, which it was well nigh hoped, had become an extinct
superstition. (Nightingale, CW 9: 59–60)
The insult to Simon’s credibility as a scientist—the association

of the revered doctor and social policy maker with trade and
prospecting—indicates her profound distaste for his position
and (whether her accusations were fair or not—and there is
little evidence to suggest they were fair) her recognition of
the political and economic motivations that often drove sci-
entific inquiry. A letter she sent two weeks later to Sidney
Herbert also discussing the 1858 Board of Health Report
may help in part to explain her deep distrust of Simon. She
writes, “[The Report] puts forward a scheme of statistics (sim-
ply trash) to prove that sanitary precautions have been greatly
overvalued, that epidemics are inevitable and that quarantine
is to be substituted for sanitary improvement” (CW 9: 65).
Simon’s willingness not only to use maps, but also statistics
to illustrate a hypothesis, rather than the results of an ade-

quate (according to Nightingale’s standards) empirical inves-
tigation, angered her enough that in 1859 when Simon was
proposed as an ideal member for the committee to head the
Royal Commission investigating the sanitary conditions of
the British Army in India, Nightingale successfully used her
behind-the-scenes inf luence with Stanley, Sidney Herbert
(the Royal Commission on India Chair), and others to block
Simon’s appointment to the committee.
Nightingale found a more acceptable explanation for dis-
eases transmitted through the air and water in William Farr’s
classification of cholera (following the work of German chem-
ical theorist, Justus Von Leibig) as a zymotic disease, caused in
Farr’s version by organic matter that “was swallowed and set
up a process of decomposition within the victim’s body which
effectively reproduced the poisonous process of decomposition,
both in the body and in its evacuations, thus permitting the
disease to be transferred when another person ingested food
or drink contaminated with those evacuations” (Hamlin, A
Science of Purity, 132). Farr, Statistical Superintendent of the
General Register Office and a member of the Committee of
Scientific Inquiries in 1854, later worked with Nightingale on
her analysis of the statistical data she acquired on the health
of the British Army in the Crimea and helped her to develop
her views on sanitation. Where Snow’s study had searched for
evidence to fit his hypothesis, Farr’s cholera studies involved a
broad statistical study that considered numerous environmen-
tal, demographic, and social factors before arriving at its con-
clusion that cholera was a zymotic disease.10 For Nightingale,
Farr’s category of zymotic disease helped solve the problem of
contaminated air and water, as Farr concluded that zymotic
diseases were preventable if hospitals and homes followed
proper sanitation measures.
Disease Rhetoric and Sensation

Nightingale wisely did not try to explain in detail in Notes
on Nursing her own complex understanding of the debates
circulating within medical and reformist circles about disease

origins and means of transmission. It may be that, as a means of
coping with the difficulty of confronting the question of how
air, sheets, curtains, etc., infected by body products should
be viewed by the readers of Notes on Nursing, Nightingale
allows her sanitary advice to be infiltrated by the language
of fictional narrative. Instead of appealing to statistics and/
or the language of science, she uses language reminiscent of
the sensational tabloid—at just the time when sensation novels
were beginning to be popular among the middle-class read-
ership she envisioned. In describing the workings of environ-
mental contaminants, Nightingale employs metaphors of the
silent and unobserved invasion of the middle class home. She
interjects, for example, the following anecdote into her discus-
sion of the kinds of inadequate hygiene that may cause disease
and even death:
A short time ago a man walked into a back-kitchen in Queen

square, and cut the throat of a poor consumptive creature, sit-
ting by the fire. The murderer did not deny the act, but simply
said, “It’s all right.” Of course he was mad.
But in our case [the case of inadequate hygiene], the extraor-
dinary thing is that the victim says, “it’s all right,” and that
we are not mad. Yet, although we “nose” the murderers, in
the musty, unaired, unsunned room, the scarlet fever which is
behind the door, or the fever and hospital gangrene which are
stalking among the crowded beds of a hospital ward, we say,
“It’s alright.” (Notes on Nursing, 14)
Of course, sensation fiction of the 1860s also often took its

plots from current public scandals, bigamy trials, female mur-
derers, etc. These popular novels stress vigilance and dispas-
sionate observation as the only effective way of combating the
insidious behavior of master criminals, such as Count Fosco in
Wilkie Collins’ The Woman in White. Both the novel’s hero,
Walter Hartright, and its heroine, Marian Halcombe, write
extensively in their journals about the need to observe ratio-
nally and without prejudgment to defeat Fosco.
It seems no accident that the novel also features a hypo-

chondriac, Marian Halcombe’s uncle, Arthur Fairlie, who
obsesses over the cleanliness and ventilation of his home with
a zeal reminiscent of Nightingale herself. Fairlie also insists
that people keep a comfortable distance from him, as he’s sure
that their noise will affect his constitution so dramatically as
to make him ill. Like Nightingale, Fairlie uses fear of illness
to conduct household management with an iron hand. Fairlie,
and for that matter the novel’s hero Hartright would surely
agree with Nightingale’s assertion that “Apprehension, uncer-
tainty, waiting, expectation, fear of surprise, do a patient more
harm than any exertion” (Notes on Nursing, 38). He would
appreciate too that Nightingale insists that nurses “value the
patients ‘fancies’ as reliable indicators of what will make them
well” (Notes on Nursing, 59). Both Fairlie, the fictional char-
acter, and Nightingale spent most of their time retired to their
rooms, insisting on quiet, cleanliness, and distance from other
people. Collins suggests (as some historians have suggested
of Nightingale and other nineteenth-century invalids) that
invalidism, for Fairlie, is a strategy deliberately employed in
order to avoid his traditionally gendered social responsibilities
as uncle to a young ward. Fairlie claims infirmity while he
paints and enjoys his leisure. Nightingale, on the other hand,
used her sickroom as a place from which to influence public
health policy and policy makers while avoiding the social
responsibilities of a ruling class lady. While Nightingale clearly
used her time in her sickroom productively, I do not mean
to suggest that her invalidism was entirely for her a strategy
to avoid domestic responsibilities. Biographers seem now to
agree that Nightingale struggled throughout her life begin-
ning well before her return from the Crimea with what many
now think was brucellosis, a painful and debilitating illness.11
Fairlie’s presentation of his needs as a result of his invalid-
ism echoes many of Nightingale’s prescriptions for caring for
invalids. At the same time, the sensational reactions of the
novel’s general narrator Hartright to people, events, and set-
tings (including the fabulously named Blackwater Park—with
its obvious connotations of cholera) despite his conscious
efforts to observe all natural phenomena calmly and rationally,

provide a kind of comic commentary on the sensationalism
of sanitary rhetoric. In Notes on Nursing, Nightingale sets up
the rather startling analogy between the sensational tabloid
murder and the infection of the home through contaminants
to shock her readers into complying with her prescriptions for
household hygiene, but she insists also that the emphasis on
strict observation must go further. She extends the discus-
sion of the importance of vigilant empirical observation and
detection into her later prescriptions for how a nurse (and,
Nightingale argues, “every woman is, at one time or another,
a nurse” 3) might observe the symptoms of death correctly.
She describes the different colors faces actually take in death’s
various stages, while observing that novels seem de rigueur
to assume the coloring of the dying is white. The coding of
death in novels, according to Nightingale, is not “true to life”
(199–220, 120n), or accurate in detail, something that the
Pre-Raphaelite poets, artists, and the sensation fiction writers
of the 1860s would have insisted that they be.12
In Nightingale’s sensational story of the intruder—the
intruder representing, of course, disease in general, and epi-
demic disease in particular—the culprit is ultimately the
English middle-class woman who has allowed the disease into
her midst through poor household management. Moreover,
she indicates that the nurse must have training to report the
evidence of death or disease that is actually in front of her,
rather than reporting that evidence via the influence of sensa-
tional accounts of death in novels. Interestingly, The Woman
in White’s central narrator and editor, Hartright, obsesses
over his own powers of observation. He frets when his abil-
ity to observe things dispassionately has been altered by the
shocks his system has received in the course of trying to solve
a mystery. He writes:
I began to doubt whether my own faculties were not in danger

of losing their balance. It seemed almost like a monomania to
be tracing back everything that had happened. . . . I resolved,
this time in defense of my own courage and my own sense,
to come to no decision that plain fact did not warrant, and to

turn my back resolutely on everything that tempted me in the
shape of surmise. (69)
Hartright’s decision to work inductively from evidence that

presents itself and to turn away from presuppositions resem-
bles the prescription Nightingale places on her middle-class
female reader to review the evidence of death and illness
exactly as it appears and without the influence of novelistic
accounts of these phenomena. Hartright credits his ability to
observe dispassionately to his training as an art student. But,
like Nightingale, he claims that such objective detachment
must be learned: “No uninstructed man or woman possesses
it,” he claims, and “most [are] universally insensible to every
act of Nature not directly associated with the human interest
of their calling” (44). This type of training in objective and
dispassionate observation was primarily encouraged in young
men through nature study, math, and science. Natural history
proponent Charles Kingsley, for one, encouraged nature study
for young men, in particular, because to him it represented “a
path of mental honesty; a study in which [young people] shall
be free to look at facts exactly as they are.” It thus provided
a means of protecting the youthful imagination from being
“thrown inward, and producing a mental fever, diseasing
itself . . . by feeding on its own . . . morbid feelings.” (Kingsley,
“How to Study Natural History” 94). For Nightingale, as for
Kingsley, training in neutral, objective observation, should
turn young minds away from indulgence in sensational texts.
Unlike Kingsley, at least in his didactic natural history tracts,
Nightingale and Collins are quite willing to exploit the feel-
ings of their readers to prompt them into action or reaction.
And yet, even when adopting sensationalist rhetoric,
Nightingale remains careful not to adopt the much more
popular language of moral contagion, or disease as a form
of divine punishment for bad conduct, that was present also
in works by prominent fiction writers of the day. Charles
Dickens, for example, indicates a belief in the mutual relation
between moral and physical contagion through the narrator of
his 1846 novel, Dombey and Son. In this passage, for instance,
the narrator explains the inseparability of poor physical and
moral conditions among the poor in the most wretched of
living conditions
Those who study the physical sciences, and bring them to bear
upon the health of Man, tell us that if the noxious particles that
rise from vitiated air were palpable to the sight, we should see
them lowering in a dense black cloud above such haunts, and
rolling slowly on to corrupt the better portions of a town. But
if the moral pestilence that rises with them, and in the eternal
laws of outraged nature, is inseparable from them, could be
made discernible too, how terrible the revelation! (Dombey and
Son, 669–70)
Here, moral contagion appears in constant conjunction with

environmental contaminants; it “rises with” and “is insepa-
rable from” the presence of such “noxious particles.” But
Dickens goes even further to insist that the inseparability of
environmental pollutants and moral contagion is an “eter-
nal” law of “outraged nature.” In other words, the claim goes
beyond what an empiricist might observe about the habitual
association of two things, beyond statistics and the observ-
able, to create a law akin to the laws of nature. This is one step
further than Nightingale is willing to allow in her own argu-
ment. There is no place for the language of moral contagion in
her work, especially not when it is connected to a theory that
assumes a relationship between morality and natural law. This
contrasts with the views of prominent politicians and social
reformers of her day, such as James Phillips Kay and Edwin
Chadwick, who made just such claims.13
In creating her narrative about the culpability of the unob-
servant middle-class woman in the case of the murderous
intruder, Nightingale sets up her later empiricist argument
that women have no inborn ability to perform the necessary
vigilant observation and detection of such intruders. However
much she may be willing to sensationalize her point by per-
sonifying disease as an evil intruder, metaphysical arguments
about women’s natural abilities to nurture, care, and sym-

pathize have no place in Nightingale’s narrative of training
good household managers. Instead, she wants her readers to
see that effective nurses and household managers need to be
trained in empiricist observation of hygienic matters affecting
the home.14
In her zeal to recruit young English women to her cause,
however, Nightingale compromises her own claims to strict
empiricist logic. Though she wants to deny that women as a
gender are naturally suited to nursing because of their pur-
ported powers of sympathy, she is willing to make an entirely
non-empirically based, nationalist argument about English
women’s superior natural capacity to learn empiricist obser-
vation of the home. To understand why she might make such
a seemingly unscientific claim, consider again Freedgood’s
notion of the “short-acting” cures Nightingale’s texts offer to
social problems. Nightingale insists that women need train-
ing in proper methods of home and patient observation and
sanitary practices. And she is willing to use the sensational-
ized rhetoric of the intruder invasion to prompt her reader to
take up the task of household surveillance. Thus she makes the
problems of dirty sinks, drains, and walls alarming, while at
the same time suggesting a solution to these problems: cool,
dispassionate vigilance over the home and patient. That solu-
tion, however, requires an entire retraining of the household
manager according to scientific, detached methods of obser-
vation for which her limited education has not prepared her.
Thus Nightingale reacts to that challenge by ascribing to the
English woman a superior “natural” capacity for good empir-
icist observation. She writes,
But I think in no country are women to be found so deficient

in ready and sound observation as in England, while peculiarly
capable of being trained for it. The French or Irish woman
is too quick of perception to be so sound an observer—the
Teuton is too slow to be so ready observer as an English woman
might be. Yet women lay themselves open to the charge that
is so often made against them by men that they are not to
be trusted . . . for want of a practiced and studied observation.

(Notes on Nursing, 113)
In claiming an ability to measure “capability,” which would

seem to be like a person’s capacity for love or imagination—
impossible to observe empirically—Nightingale moves away
from her insistence on the strict observation of phenomena in the
interests of encouraging nationalist fervor for her own agenda.
This “fast-acting” solution will have inspired anxieties in her
female readers about “proving” their Englishness, prompting
them to act according to Nightingale’s prescriptions.
Nightingale’s enthusiasm for encouraging women in the
arts of observation and even surveillance, which she sees as
requirements for the competent nurse, ultimately requires that
her rhetoric move into the metaphysical and fictional realms.
Ultimately Nightingale encourages the same kind of reliance
on the sensational narrative that she criticized in others in
Notes on Hospitals. Both her insistence on the need for strictly
non-metaphysical approaches to disease diagnosis and preven-
tion, and her call to eschew theoretical speculation as to the
causes and means of disease transmission are undone by her
own arguments in Notes on Nursing.
It may be impossible to determine whether or not
Nightingale deliberately confuses the empiricist and metaphys-
ical arguments she makes about bodies in Notes on Hospitals
and Notes on Nursing. Given her passionate endorsement of
sanitary principles supported by statistical and empiricist evi-
dence, however, it seems important to try to reconcile how she
can argue in Notes on Hospitals that empiricist study reveals
the falsehood of contagion theory, while in Notes on Nursing
her sensational narrative of how bodies infect the sickroom air,
curtains, and linen, implies the presence of contagions attrib-
utable to the inept household manager. The most compelling
explanation of the apparent inconsistency in her rhetoric and
message is that she felt that a sensationalized rhetoric which
exploited fear of contagion and gave special capacity for obser-
vation to English women would inspire her readership into
action.
Changing Perception: Nightingale

on Germ Theory
Nightingale’s willingness to manipulate her readers’ views of
the contagion question in the late 1850s and early 1860s has
implications for our understanding of the combination of sci-
entific insight and political astuteness that historians and lit-
erary critics have (or in some cases have not) been willing to
grant her.
Hugh Small’s recent book Florence Nightingale: Avenging
Angel, for example, claims in passing that hitherto unno-
ticed evidence from a short essay privately circulated, “Notes
on Contagion and Infection” (1858), prove that Nightingale
actually privately accepted the notion that unobservable germs
might cause disease.15 “On careful examination,” he claims,
“the widespread allegation that she refused to accept germ
theory turns out to be false.” (4). He justifies this claim on the
basis of a passage from “Notes on Contagion and Infection”
where Nightingale says, “There are two or three diseases in
which there is a specific virus which can be seen, tasted, smelt,
and analysed, and which, in certain constitutions, propagates
the original disease by inoculation, such as small pox, cow pox,
and syphilis, but these are not ‘contagions’ in the sense sup-
posed” (Qtd. in Small, 143). The passage shows Nightingale
accepting that there is such a thing as contagion via observable
viruses, those “which can be seen, tasted, smelt, and analy-
sed,” and sometimes transmitted via actual inoculation. But
she regards this sense of contagion as irrelevant to contagion
theory as she sees it, whereas Small thinks this passage indi-
cates that Nightingale should therefore see no difficulty in
accepting any version of contagion theory. His reading does
not distinguish adequately between the two kinds of contagion
Nightingale proposes: (1) contagion via observable viruses and
actual inoculation (this she grants as possible because it con-
forms to her belief that God provides humanity with empir-
ical evidence of disease), and (2) single exposure contagion
via unobservable agents, transmitted via the clothing, air, and
effluvia of the infected. It is true that neither theory is entirely
compatible with her notion that disease originates in and is

transmitted through the environment. On the other hand, on
purely empiricist grounds, Nightingale could have accepted
contagion or infection via observable viruses, in certain iso-
lated cases, without yielding any ground whatever on conta-
gion via unobservables.
Small’s theory that Nightingale actually privately endorsed
germ theories of the second sort, if true, would initiate a rad-
ical change in the perception of Nightingale, as his theory
would surely leave her open to accusations that she was willing
to put patients at terrible risk of catching contagious disease
when she wasn’t willing to admit she was wrong about con-
tagion. For example, she insisted as late as 1860 that, “With
proper sanitary precautions, diseases reputed to be the most
‘infectious’ may be treated in wards among other sick with-
out any danger” (Notes on Hospitals, 10) Thus, I suppose, she
would have claimed that even cholera or scarlet fever patients
might have been kept without danger in the same room with
other patients.
Small also claims that Nightingale’s invalidism following
her return from the Crimea was the result of her becoming
“literally crippled by her feelings of guilt” from not having
recognized until after the war the devastating effects on her
patients’ health of infected air and water—matter Small asso-
ciates with contagion theories (4). In a highly dramatic para-
graph Small suggests that Nightingale’s acute illness in 1857
following her return from the Crimea and her years of inva-
lidism were the result of her sense of personal responsibility for
the deaths of her Scutari soldiers:
[Sidney] Herbert had, after all, selected an expert to implement

his ill-thought-out-vision of a general hospital remote from the
battlefields. A person who was supposed to be present on the
spot, equipped with a regional intelligence network covering
all the hospitals in the war zone, and who reported directly
to the Minister of War in London. A person who was one of
the world’s recognized experts in hospital management, not
just an impractical philanthropist. In charge, trained for the

job and equipped with unprecedented powers, there was one
person who could have made the whole Scutari experiment a
success. It was this person, [Nightingale] seems to have con-
cluded, whose shortcomings had caused the loss of an army.
This person, of course, was Florence Nightingale. (119)
Small’s assertion is correct that she changed her views (under

the influence of Farr’s tutelage) about the high mortality rate
of her hospital in Scutari from initially attributing it to “inad-
equate food, overwork, and/or lack of shelter” (88), to later
claiming that contaminated air and water were to blame; but,
as I have explained, contagion for her meant something differ-
ent. Prior to 1883 Nightingale still attributed disease origins
to environmental causes, even if she accepted that some few
diseases could be transmitted via observable viruses or inoc-
ulation. In an explanatory footnote in Notes on Nursing, for
instance, she presents just such a view of disease origins:
I was brought up, both by scientific men and ignorant women,

distinctly to believe that small-pox, for instance, was a thing
of which there was once a first specimen in the world, which
went on propagating itself, in a perpetual chain of descent, just
as much as that there was a first dog, (or a first pair of dogs,)
and that small-pox would not begin itself any more than a
new dog would begin without there having been a parent dog.
Since then I have seen with my eyes and smelt with my nose
small-pox growing up in first specimens, whether in closed
rooms, or in overcrowded wards, where it could not by any
possibility have been “caught,” but must have begun. (Notes
on Nursing, 32n)
Nightingale emphasizes what she has seen and smelt as empir-

ical evidence of the origins of small-pox, a disease that had,
since well before 1858, been shown to be transmittable via
inoculation. And for Nightingale, the fact that a disease could
be transmitted via inoculation did not indicate that it had
originated in any way other than environmentally.
Nevertheless, I do find Small’s observation that there is

some evidence to suggest inconsistency within Nightingale’s
anti-contagionist rhetoric provocative; her unwillingness to
address scientific questions of contagion in Notes on Nursing
anywhere but footnotes is intriguing as well. But what
Small’s evidence showed me was not so much an inconsistent
embrace of contagionism as a mere appearance of inconsis-
tency brought on by her rhetorical strategies, particularly in
Notes on Nursing and Notes on Hospitals. The inconsistencies
Small observes may be taken as an indication that Nightingale
feared that the germ theory hypothesis could be true. As a
rational thinker she could hardly fail to entertain this pos-
sibility. Even if that possibility were realized, however, the
greater worry for Nightingale would still be that belief in
contagion theory would allow people to ignore the impor-
tance of proper hygiene. This explains as well her anger with
Snow and Simon for their assertions about the uselessness of
sanitation measures.
My suggestion of Nightingale’s willingness to exploit fears
of contagion in the interest of raising readers’ awareness of
sanitation issues in Notes on Nursing is also consistent with her
much later willingness to endorse contagion theories only in
public writings addressed to limited, carefully chosen popula-
tions. Lynn McDonald argues in an as-yet-unpublished essay,
that the still widely held view that Nightingale never aban-
doned her hostility to the theory of germs turns out not to
be true. Shortly after Koch discovered the cholera bacillus in
India and published his findings (1883), Nightingale wrote
explicitly about germs and contagion for Richard Quain’s
Encyclopaedia of Medicine. Nightingale’s willingness to end-
orse Koch’s findings is not surprising given the strict empiri-
cist criteria Koch used to test his findings, which McDonald
describes here:
Koch’s “four postulates” for establishing a bacillus as a dis-

ease agent set a high test: that the bacteria must be present in
every case, be isolated from the host and grow, be reproduced
when inoculated into a healthy host and be recoverable from
experimentally infected hosts. In the case of cholera he could

not get the bacilli to grow in a healthy host (an experimental-
animal), for cholera is not a disease of non-human animals. He
did however succeed in persuading the scientific world and
even Nightingale came to understanding that germs and their
environment were not an either-or proposition. (McDonald,
“Nightingale and Germ Theory,” 8)
After 1883 Nightingale even made proposals for illustrations

of germs acting on bodies to be shown to Indian villagers in
efforts to encourage sanitation reforms.16
It is significant, however, that she appears never to have
used the words “contagion” and “germs” uncritically else-
where and even tried to get references to them stricken from
works addressed to broader populations in England because
she felt that too many people would mistakenly take up super-
stitious beliefs about contagion, undoing her sanitary efforts.
As chapter 3 will address more fully, Nightingale was at odds
with medical researchers wanting research funds that she felt
should be channeled to sanitation.
Tracing her shifting public and private stances on the
anti-contagion/contagion debate reveals a strategic, practi-
cal, empiricist thinker. For example, responding to Dr. W. C.
Maclean’s criticism of her anti-contagionist stance, which
appeared in The Lancet in 1870, Nightingale wrote that her
object in challenging contagion theories was “purely practical.
It was to deprecate a tendency complained by all of late years
(this very complaint came to me from India) viz. the tendency
to base sanitary proceedings on theory” (725).17 Nothing in
her public writings or private correspondence shows her explic-
itly converting to contagionism prior to 1883.
Nightingale’s public and private writing about how belief
in contagion might negatively influence public policy provide
just one example of how Nightingale chose her words and the
kinds of allusions she would make to other texts in ways that
shifted strategically according to her audience and situation.
Her careful rhetorical positioning with respect to disease the-
ory, as well as her considered understanding of the social and
political effects of promoting her views on the question show

a careful, practical thinker oriented toward achieving results,
saving lives—eager to solve as many of the sanitary problems
of her era as she could using whatever rhetorical means she
thought would best persuade her readerships.
Chapter 2
On Gi v i ng: Poor L aw R e for m,

Wor k, a n d Fa m i ly i n Nigh t i ng a l e ,
D ic k e ns, a n d St r e t t on
A fter the enormous popular and critical success of Notes on

Nursing as well as the respectful reviews of Notes on Hospitals
Nightingale adjusted the focus of her reformist work in order
to pay more attention to two goals: exposing flaws in the work-
house system under the 1834 New Poor Law Amendment
Act, and gathering information on sanitary problems and
famine in India.1 Nightingale’s writings about domestic issues
from the mid 1850s through the late 1870s—both her private
correspondence and public writing—concentrate on reform-
ing the Poor Law Workhouse infirmary as well as exposing
larger problems in how prominent government officials and
philanthropists engaged with urban sanitation problems, ill-
ness, and poverty. Her efforts in all of these areas were com-
plicated by her recognition of the power that her fame gave
her to influence the public to act for the social good, and her
reasoned distaste for the very fame that gave her such a mea-
sure of social power.
Reviews for Notes on Nursing and Notes on Hospitals in the
1860s reflect the status that Nightingale’s first-hand nursing
experience in the Crimea had given her in the British public.
One reviewer writes, “[S]he tells us what ‘her eyes have seen
and her nose has smelt,’ and what came of it all. She arms us
with an authority, with a name which the poorest and the
most ignorant know and love. She puts our convictions into
maxims which can be repeated, and which may give force to
our feebler remonstrances.”2 The stress the reviewer places
on Nightingale’s abilities as an accurate witness to empirical
truths (“what her eyes have seen and her nose has smelt”) sub-
tly links Nightingale’s authority as witness to the Crimean
war effort with her authority to act as a guide to women in
household maintenance. Then, the reviewer allows the reader
to feel that this kind of evidentiary authority can be passed
from Nightingale to the reader herself as “she arms us with an
authority,”—authority the reader could draw both from the
information about hygiene Nightingale had provided as well
as the reader’s ability to invoke the Nightingale name as she
claimed her sanitary expertise within her home.
I suspect that the reviewer has tapped into one of Nightingale’s
goals in Notes on Nursing: to provide women with a sense of
their own authority, borrowed in essence from Nightingale.
She gives her reader the ammunition she needs to claim her
function as a bulwark for her family and the nation against the
entry of disease into the home. And while Nightingale may
have succeeded to some extent in her goal of arming women
with domestic authority, she also had to accept that much of
the Victorian public considered her work and its legacy quite
differently. In 1865, for instance, a mini-biography in the
Reynold’s Miscellany stressed Nightingale’s sympathy and phi-
lanthropy, rather than her teaching of hygienic principles, as
her lasting legacy. This writer claims that, “The deep interest
which attaches to the name of Miss Florence Nightingale will
never be obliterated from the pages of history, so long as we
have sympathy for the British soldier on the battle field. Hence
the Portrait of this philanthropic lady will ever be welcome to
the homes of her countrywomen and indeed, to every home in
the civilized world” (“Miss Nightingale,” 165).3 Philanthropy
interpreted here as the sympathetic giving of time, work, and
money, in a self sacrificing way, would dominate portraits of
Nightingale such as these for most of her lifetime. Even the
On Giv ing 39
public’s fascination with the information offered in Notes on

Nursing would not be enough to shift the general view that
Nightingale’s true expertise was to be found in giving and
inspiring sympathy.
The sensational aspects of Notes on Nursing were, however,
appreciated by the book’s critics. An 1860 essay in Fraser’s
Magazine for Town and Country, inspired by the author’s
reading of Notes on Nursing, provides a melodramatic inter-
pretation of Nightingale’s work:
I heard everybody about me talking of Miss Nightingale’s

Notes on Nursing, and quoting extracts from it. I took up the
book myself, not thinking I should find it very interesting,
nor imagining it would much concern me, as I have decidedly
no vocation for nursing. I read it through, however, with-
out stopping, for I found that it had some of the interest of
a novel. Always before you, there is the hero of the tale, an
emaciated being, with sad wistful eyes, who depends upon
good nursing as his best, perhaps his only chance of life. (“A
Reverie,” 757) 4
This writer felt the novelistic quality of Nightingale’s essay,

which I discuss in chapter 1, rather than its sanitary argument
and even invented a fictional “hero” for the story, interestingly
leaving the nurse character out of the heroic role—she, as an
individual, is circumscribed entirely by her role.
Examples such as these of Nightingale’s reviewers and
appreciators’ misrepresentations of the thrust of her book help
explain what may seem an odd reluctance on Nightingale’s
part to be represented as a philanthropic heroine for her
efforts on sanitation, poverty, and the like. She rarely was
willing to use her fame in the interests of agitating for partic-
ular social reforms, and with a few important exceptions she
disliked most fictional and nonfictional narratives of heroic
philanthropy in women. In this chapter I suggest that her
attitude was strategic and can be explained in a few ways:
Nightingale may well have been invested in the idea of her-
self as an exception to the norm—a woman uniquely capable
of handling social and intellectual interactions with men in

the social sphere while sustaining her own philosophical and
moral views. Further, it cannot be ruled out that she may
have been invested in a kind of sororophobic competition
with other prominent female social reformers for the role of
social prophet, a suggestion that Catherine Judd has made
in connection with Nightingale’s intensely negative reaction
to George Eliot’s portrait of Dorothea Brooke’s fate in
Middlemarch, a subject I take up at length in the chapter 3.5
But these explanations don’t address Nightingale’s desire to
work primarily outside of the public eye—seldom publishing
her voluminous writings on Poor Law reform, Indian sani-
tation, and other reform issues—and instead working tire-
lessly behind the scenes. Illness and invalidism, other possible
explanations for her retreat from the public sphere, may have
contributed to her decision to appear in public only rarely,
but they too don’t account for why she published only the
tiniest fraction of her extensive work on the issues to which
she devoted her life following her return from the Crimea.
Despite her reluctance to capitalize on her Crimean fame
and the public perception of her as a philanthropic heroine,
Nightingale did, however, endorse some few fictional and
nonfictional narratives that featured women working actively
for the social good outside of the home. These texts depict
women who utilize their moral, physical, and intellectual
strengths to better the lives of others, often creating along the
way affiliative families to fill the gap in mentorship and care
left by broken and dysfunctional families, poverty, illness, and
the like.6 Many of these works contain no romantic plot, fea-
turing instead scenes of Dickensian sentimentality involving
children, the sick, and the aged. As we will see in the final sec-
tion of this chapter, Nightingale’s choice of which narratives
of female philanthropy and social reform she would endorse
reflects a calculated strategy on her part to move the public to
agitate for the poor in the ways she saw as most effective. Her
choices also reflect her reaction to the philanthropic “scene”
of the day, one which, in a fashion similar to today’s, was af-
fected by scandals, stereotypes, and the growth of a kind of
On Giv ing 41
celebrity philanthropy which Nightingale herself had unwit-

tingly inspired.7
To explain these conclusions I explore Nightingale’s own
writings and writings about her engagement in Poor Law
reform and philanthropy from the late 1840s through the
late 1870s. These writings address governmental and private
efforts to alleviate poverty through Poor Law reform, as well
as institutional and individual acts of charity. I consider too
the types of fictional and nonfictional narratives she bought
and donated to reading rooms for soldiers, nurses, hospitals,
and charitable institutions. The buying and donating of books
was a form of philanthropy that Nightingale participated in
enthusiastically and I suggest here some reasons why that
might have been so.8 I focus on the works of two writers,
those of her beloved Dickens and those of Dickens’s friend
Hesba Stretton, author of over fifty works, including novels,
most of which were religious in nature and intended for chil-
dren. Like Dickens Stretton worked with Angela Burdett-
Coutts in charitable endeavors, in her case helping found the
London Society for the Prevention of Cruelty to Children
in 1884 and collecting money for Russian famine relief in
1892.While Nightingale purchased books by many authors,
Dickens’s and Stretton’s novels are representative of two types
of literature that conveyed attitudes about philanthropy with
which Nightingale appears to have felt sympathy: those which
represented successful individual middle-class efforts at phi-
lanthropy motivated by sympathy often against the backdrop
of flawed bureaucratic models of philanthropy, and those that
depicted the poor enacting reform in their own communities
out of moral compulsion and sympathetic concern for each
other.
It is especially revealing to consider Nightingale’s own
published and unpublished writings about Poor Law reform
within the context of two other types of sources: first, records
of the various mid-century governmental and private efforts to
prevent and alleviate distress among the poor; and second, the
narratives about urban poverty and illness that Nightingale
bought and donated to the military, nurses, and charitable
institutions. Taken together, the writings suggest Nightingale’s

growing awareness of the increasingly fine line between fic-
tion and fact in journalism and novels. They suggest as well
Nightingale’s efforts to prevent any association of herself or
her legacy with scandalous or self-serving celebrity philan-
thropy. Nightingale’s attitudes toward philanthropy appear to
have been shaped in part by the flurry of mid-Victorian stories
of middle-class workhouse and slum visitors. Seth Koven has
defined the popular mid-Victorian practice of “slumming” as
middle and upper class men and women visiting the work-
houses, homes, and neighborhoods of the poor either for per-
sonal entertainment or philanthropic purposes.9
Nightingale’s approach to domestic reforms were shaped in
response to these social and political contexts, but two long-
held beliefs undergirded all of the positions and actions that
she took: first, her belief in the importance of government
establishing ideals by which to guide the creation and imple-
mentation of social policy related to the treatment of the poor,
sick, and the aged; and second, her recognition of the enor-
mous effects, mostly in her view negative, that sensationalized
and sentimental accounts of philanthropy contained in mid-
Victorian novels and biographies were having on the British
public—narratives not unlike those that had given the heroine
of the Crimea her role as icon and moral steward.
The Risks of Stewardship for the

Female Reformer
One of Nightingale’s more astute reviewers for her early pub-
lished work recognized the potential pitfalls for the heroine of
the Crimea in attempting to guide the behavior of the public
and government according to the rigid discipline by which
she governed her own behavior. A critic for the Christian
Remembrancer who reviewed Nightingale’s Notes on Nursing
and Notes on Hospitals together with Richard Barwell’s Care of
the Sick, recognized that Nightingale’s impulse toward steer-
ing the behavior of her public might cause her difficulty in
maintaining the adoring audience her Crimean exploits had
On Giv ing 43
earned her. Though her prescriptions for household man-

agement in Notes on Nursing and hospital design in Notes on
Hospitals would undoubtedly inspire admiration and interest
in sanitary improvements in some, it would also be likely to
offend others with her bold statements of the inadequacy of
hygiene efforts in even the finest of English homes and hospi-
tals. Before turning to a discussion of the mid-Victorian phil-
anthropic scene and how Nightingale’s writings on Poor Law
reform and philanthropy responded to it, I dwell here briefly
on this reviewer’s comments because of their insightful recog-
nition of how Nightingale was, indeed, attempting to create a
different perception of herself in these early writings than the
public perception of her as a sentimental heroine. The reviewer
writes,
We are all so accustomed to think this class of strictures [the

ones Nightingale recommends for hygiene in the middle-class
home] belongs to the poor, we are so used to associate them
with courts and blind alleys, that the bold onslaught of this
dauntless lady on the polite world takes us by surprise. She
makes no distinction between rich and poor—all are alike
ignorant to her superior discernment. There is an unsparing,
unflinching enforcing upon us the weaknesses and infirmities
of our organization, the original sin of our physical nature,
often constituting ourselves our worst company which must
make many of her readers wince. (108)10
This reviewer recognizes how Nightingale’s narrative and rhe-

torical strategies manage to discourage the development of
any kind of “cult of personality” around Nightingale herself;
she even appears to push the reader away from feeling any kind
of affectionate admiration for her. The reviewer recognizes in
this strategy a surprising lack of self-absorption in both Notes
on Nursing and Notes on Hospitals:
Every good book shows the mind of its author; and from these
few, but weighty pages, treating of the most matter-of-fact
details, with the most rigid adherence to the question in hand,
we may gather a distinct perception of the qualities of a very

remarkable mind, subjected to a training exceptional from the
concentration of all its powers to one great cause. Most self-
devotion has some enthusiasm on the face of it, some mental
exaltation, colouring the ruling idea, with hues unborrowed
from the sun. The motive which has led Miss Nightingale to
devote her life and the fullness of her powers to the benefit of
her fellow creatures, amid scenes the most repulsive and dispir-
iting to common feeling, must be akin to enthusiasm, but it
bears none of its characteristics. There are no even implied
professions. She evades in her writings, as in her public course
of action, every expression calculated to evoke comment on
herself or enthusiasm on her own behalf. Her plan is to treat
nursing as a science.11
To register how different her writings were to those of other

lady philanthropists of her day the reviewer (with some thought
to the ways his or her review might color the reader’s percep-
tion of other lady philanthropists’ work) casts the “feminine”
style of the others as “flighty” and insists that Nightingale’s
motives are pure, stated with a bluntness meant to be irre-
futable, and independent of the need for any bolstering from
“public sympathy.” The compliment to Nightingale’s motive
and work ethic in the following passage would, no doubt, have
pleased Nightingale herself:
It would seem natural to couple her books with those of some

of the other many ladies devoting themselves to good works in
our time; but they will not bear such companionship. One or
other must suffer in the conjunction. The ordinary feminine
style sounds, we must own, flighty in the contrast; while the
reader not alive to this effect, might consider the cool, pointed,
not seldom caustic vein of the heroine of the Crimea deficient
in unction, and so retire from the perusal of her pages with a
sense of rebuff, however much he may reverence the force of
that motive to good and great action which needs no stimulus
from excited feeling or public sympathy.12
This reviewer recognizes qualities in Nightingale’s early writ-

ings that will come to dominate her work for the rest of her
On Giv ing 45
career, things that set her apart from others working on the
same issues, namely Poor Law reform, and more generally the
question of how to encourage the government and its people to
develop policy and behaviors best suited to alleviate the prob-
lems facing the poor, sick, and aged. While this reviewer seems
to have caught the underlying motives behind Nightingale’s
writing in Notes on Hospitals and Notes on Nursing, her rep-
utation as “the lady of the lamp” was enough to cause other
reviewers and readers to see in Nightingale’s words only the
sympathetic heroine of the Crimea that they wanted to see.
Nightingale and the Mid-Victorian

Philanthropic Scene in Fiction
and in Fact
Nightingale’s attitudes toward Poor Law reform and those pri-
vate philanthropic efforts ostensibly intended to alleviate the
distress of the poor, sick, and aged were probably shaped in
part by the critical responses to her Notes on Nursing and Notes
on Hospitals. We see in her private writings and in the choice of
books she bought and donated to homes for soldiers, nurses,
and other charitable organizations, that she had developed
a distaste for many narratives involving self-sacrificing phil-
anthropic heroines. Her attitude toward such narratives also
likely reflects her response to the mid-Victorian satirical treat-
ment of female social reformers in the press and in fiction. The
most famous of these satires today is undoubtedly Dickens’s
Bleak House with its characterizations of Mrs. Jellyby’s tele-
scopic philanthropy that ignores domestic problems in the
interests of the fictitious African tribe, the Borrioboola-Gha,
and Mrs. Pardiggle’s more militant and invasive model of
charity home visiting. Dorice Williams Elliot has argued of
Bleak House and other mid-Victorian novels that contained
harsh portraits of female philanthropy and other forms of
female social activism, “The satires of ‘professional’ female
philanthropists and ignorant or overbearing charitable visitors
reveal these male professionals’ anxieties about competition
for authority in a newly conceived social sphere” (Elliott, 5).
The narratives Nightingale most often purchased and donated

were indeed, like Bleak House, less threatening to the rising
male middle class professionals that Elliott identifies as adjust-
ing to the presence of women philanthropists working in the
public sphere.
Lady philanthropists were particularly irritating to
Nightingale for the ways that they seemed to diminish the
potential for the poor to develop in moral character under the
influence of what she saw as the largely careless, haphazard
charity ladies offered. She saw a risk as well to the lady philan-
thropists’ own character development as they learned by the
example of others to give their money or their time sporadi-
cally, rather than giving their consistent dedicated work. As her
writing on training nurses indicates, Nightingale felt strongly
that adequate moral and physical hygiene require constant,
dedicated vigilance on the part of the nurse. In Nightingale’s
eyes, no less a commitment was required of the philanthro-
pist. Writing to Lady Elizabeth Eastlake in 1868, Nightingale
lamented,
The lady philanthropists who do the odds and ends of charity

especially in the country, all wanting in earnestness, all deteri-
orate on doing their charity, as you would expect. It is a kind
of conscience quieter, a soothing syrup. They would take no
pains to do it (or anything) as well as it can be done as a work.
And the consequence is a degeneration of their quality of char-
acter under it.13
The stress Nightingale places on the idea of charity “as a work”

reveals her sense of charity’s importance and of its potential, not
just to enrich the lives of its beneficiaries, but also those who
recognize it as a work, a responsibility, rather than a “balm”
for the conscience. What, then, for Nightingale, would have
constituted an appropriate method by which the fortunate,
particularly middle- and upper-class, women should make
efforts to alleviate the problems of poverty, illness, and age?
This question is doubly important given Nightingale’s reluc-
tance to take on women from her own social class in nursing.
On Giv ing 47
She was increasingly aware of the influence that her own

story of heroism in the Crimea was having on the attitudes
of men and women toward women’s participation in social
reform. Dorice Elliot identifies the widely circulated narra-
tives of Nightingale’s Crimean nursing work as perhaps the
key influence in persuading Victorian women of their poten-
tial to provide effective means to reform through their partic-
ipation in increasingly professionalized philanthropic efforts.
Elliot cites, for example, Anna Jameson’s 1856 claim in Sisters
of Charity, Catholic and Protestant, and the Communion of
Labor that “people were heard congratulating each other on
‘the lucky chance’ that a Miss Nightingale should have been
forth-coming just at the moment she was wanted.” Adding
later, “I trust that England has many daughters not unworthy
of being named with Florence Nightingale.”
Though she hoped that Nightingale’s example would
spur more women toward reformist and philanthropic work,
Jameson, an acquaintance of Nightingale’s,14 later in the same
book, however, warns her readers of the kind of devotion and
self sacrifice that work such as Nightingale’s involves. She
writes,
No doubt there are hundreds of women who would now gladly

seize the privileges held out to them by such an example [as
Nightingale’s], and crowd to offer their services: but would
they pay the price for such dear and high privileges? Would
they fit themselves duly for the performance of such services,
and earn, by distasteful and even painful studies the neces-
sary certificates for skill and capacity? Would they, like Miss
Nightingale, go through a seven years’ probation, to try at
once the steadiness of their motives and the steadiness of
their nerves? Such a trial is absolutely necessary, for hundreds
of women will fall into the common error of mistaking an
impulse for a vocation. (Jameson, 130–131)
This warning would have assuaged some of the concern

Nightingale continually expressed about women assuming
they had natural capacity for nursing simply by being women.
It also provided a necessary contrast to scathing portraits

of middle-class female philanthropy, such as Dickens’s self-
important Mrs. Pardiggle and neglectful Mrs. Jellyby.
Of course Jameson was hoping to use Nightingale’s celebrity
to promote in women a kind of spiritualized sense of vocation,
an acceptable public professionalism, of the kind that Elliot
identifies in the writings of Nightingale and Octavia Butler;
each of whom famously described her own “call” to duty. We
can almost see in Jameson’s adoption of Nightingale’s story
an attempt to co-opt for women the story of vocation that
George Eliot’s narrator in Middlemarch suggests is one that
as readers we never hear, our interests instead being constantly
turned by authors to what Eliot calls the “makdom and fair-
ness” of young people engaged in marriage plots.15
A note unpublished in Nightingale’s lifetime indicates,
however, Nightingale’s displeasure with Jameson’s (and prob-
ably others’) efforts to give her iconic status as a self-sacrificing
philanthropist, particularly when it appeared to be done for
the sake of putting women, such as herself, in the company
of male iconic figures. The obscure passage to which I refer
is worth quoting at length for it makes revealing associations
between Nightingale’s views on fame, social reform, gender
relations, and the various ways fame might be used to influ-
ence the public:
Why we should not have our portraits taken: (1) I wish to be

forgotten. Some of the best things the world has had done for
it have been done by we don’t know whom. I think we should
give our work to God who does it and then be forgotten our-
selves. (2) But I don’t think it worthwhile even for those I care
for most to be remembered. “Where are the great that thou
wouldst wish to praise thee?” Can you even depend on the
same thing being thought in the afternoon that was thought
in the morning? I think the greatest evil of this world is men
and women meeting together in idleness and not in work; vice
(immorality) is not what I am thinking of. That is by no means
the greatest of its consequences. It is the total misunderstand-
ing of woman’s life, of her work in the world, in men’s mind
which it brings about—and generally the misapprehending
On Giv ing 49
of men and women by each other as human beings. It is as

yet unknown for men and women to meet together to do the
world’s work (whatever Mrs. Jameson might say), for married
people as little as any.16
The associations Nightingale makes here between various

of her concerns may appear random: her movement from
declaring her aversion to portraiture done in the interest of
perpetuating one’s fame to her belief that men and women
misunderstand each other because they don’t ever do the
world’s work together, to her rather shocking claim that this
misunderstanding between the genders is a far more dam-
aging thing than vice, seems to put together seemingly only
tangentially related matters. But for Nightingale personally
these concerns appear to have been quite intimately related.
Here, in a passage immediately following the one just quoted,
she connects her concerns about sexuality, fame, and work in
surprising ways.
This being the case in living people [it being “unknown for
men and women to meet together to do the world’s work”],
it is impossible to one to see a woman’s statue in a drawing
room or a man’s either for that matter, doing nothing. I think
it is indecent. I have seen the statue of Diana Artemis without
any more clothes on than [she was born in]. Atalanta [sic] in
Calydon had nothing but a ray of a veil on, I suppose because
such clothes would have hindered her work. And these do not
appear to me indecent (improper). I have been a matron of
a hospital—the only position in which a woman is really in
charge of full-grown men, and that does not appear to me to
be indecent. I have lived a more public life then ever queen or
actress did. And that does not appear to me to be improper.
But it is improper to my mind to see a man’s or a woman’s por-
trait staring, doing nothing, in an idle assemblage of men or
women or men and women. (CW 8: 94–95)
Nightingale’s preoccupation here both with dissociating wom-

en’s work from vice and creating a new kind of association
between leisure and indecency, indicates the degree to which
she was troubled by the implicit connection so often made by

her contemporaries between work and sexuality, a connection
that appeared in novels and in reformist and medical tracts.17
Nightingale’s interest in finding ways for women to work for
the public good without fear of association either with sexu-
ality or with self-absorption shape much of her writing about
reform.
Another related feature of the mid-Victorian philanthropic
“scene” that appears to have influenced how Nightingale devel-
oped her complex approach to her Poor Law reform writings
involved the mid- to late-Victorian phenomenon Seth Koven
has called “slumming.” As Koven describes it, the sensational
journalism of James Greenwood and others who emulated
his infamous workhouse sketches set off a fad in workhouse,
home, and slum visiting. Greenwood’s first essay for the Pall
Mall Gazette, “A Night in the Workhouse” (1866), helped to
initiate a fascination on the part of the middle and upper-
class public with visiting lower-class workhouses, homes, and
urban neighborhoods, sometimes disguised as slum denizens,
and sometimes not. The goals of those who made such visits
(both disguised and undisguised) varied: some came to bear
witness to the sexual and social conditions of life among the
poor either in sensational exposés, such as Greenwood’s, or in
purportedly scientific attempts to account for the numbers of
the poor and their living conditions for the purposes of public
health (Koven, 6). Some came for the vicarious experience of
living as a poor person temporarily free from the tighter social
prescriptions on gendered and sexual behavior experienced by
the middle classes. The slums provided a place where some
members of the aristocracy and gentry could give themselves
greater sexual and social license without (it was assumed by
some) fear of retribution or public responsibility.
As Koven has described, the narratives produced by such
slum visitors contained a mix of fact and fiction in a similar
fashion to some eighteenth-century journalism; for example,
the Spectator’s collections of letters to the fictional editor,
Mr. Spectator, often contained, among real readers’ letters,
ones that were actually written by the editor Addison under a
On Giv ing 51
pseudonym. His responses to the letters allowed him to hand

out a healthy dose of social and moral instruction on the issues
he wished to address. In a similar fashion, the Victorian jour-
nalists’ and fiction writers’ portraits of life among the poor
often combined some fact with invented stories in the interests
either of spreading a moral message to readers or of infecting
the public with a particularly sensational tale in order to sell
papers.
For Nightingale such journalism was a source of concern.
As we have seen, her own fame had been the result of her will-
ingness to experience first hand and report back the fright-
ful conditions that the sick and wounded experienced in the
Crimea. But as more and more sensational narratives that
blended fact and fiction became popular, one would have to
wonder what effect might such sensational stories have on the
ways that “real” stories (such as Nightingale’s own) involving
personal experience of harrowing situations were interpreted
and respected? Moreover, the spate of popular narratives about
middle-class workhouse and slum visitors had made it difficult
for the public to discern exactly how to think about the kind
of expertise Nightingale’s public had always claimed for her—
that of the professional and sympathetic caregiver and witness.
The most famous of the mid-Victorian workhouse visitors,
Greenwood, (perhaps more than any other workhouse visi-
tor) had helped to create this confusion between the authority
that should be afforded the expert observer and the “ama-
teur” performer who claimed to get more accurate details by
pretending to be one of the population he or she observed,
rather than presenting himself as the outsider that he was. As
Koven describes, Greenwood had “gone to great expense to
acquire a costume to impersonate someone who cannot afford
decent clothes. The details [in Greenwood’s description of
his costume] ostensibly illustrate Greenwood’s authority as
an ethnographer of the poor” (Koven, 37).18 It seems highly
likely that the popularity of eye-witness reporting by those
acting roles and using their narratives either to draw atten-
tion to the need for reforms or to sell papers may help explain
why Nightingale protected as much as possible the way that
her story was told, giving her name only to organizations and
causes to whom she was willing to devote her work.19
As we’ll see in both her Poor Law reform work and her writ-
ings about Indian sanitation and famine, Nightingale worked
on how to represent the poor in ways that could not be inter-
preted as opportunism, or dilettantish dabbling in the fates of
others less fortunate. And she struggled to present the sub-
jects of her writing without devolving into raw sentimental-
ism. While her protection of how her story was told could be
interpreted unsympathetically as self absorption or excessive
concern with personal privacy, many of the views Nightingale
expresses in such writings are consistent with those she pre-
sented in her earliest published and unpublished writings, long
before her Crimean exploits. The desire to provide moral and
practical stewardship to the poor, which Nightingale expresses
throughout her Poor Law reform writings, also indicates her
concern with trying to dissuade those who lacked sufficient
grasp of the issues involved from intervening in “the world’s
work” without sufficient training and without examining their
own motivations.
Shaping Reform: Nightingale on

Governments and the Press
Thus far, I have concentrated mostly on how Nightingale
responded to public perceptions of herself and her work, and
of philanthropic work in general. My focus has in some impor-
tant respects put the cart before the horse: Nightingale’s views
on all of these matters were not derived primarily from her
reacting to public perception; that was a secondary, but impor-
tant, consideration. Her views developed, much earlier than
her political savvy did, from deeply held philosophical, moral,
and religious beliefs. Later, having adjusted personally to the
ways that her fame circumscribed how she could act to bring
about social change, she recognized the need to adapt her ide-
als of how reform should work to practical constraints. These
included considerations of the ways that popular fiction, the
press, and other media shaped public opinion. Her sense of the
On Giv ing 53
obstacles popular opinion created to getting real work done on

poverty and health initiatives is evident throughout her post-
Crimea writings. Here, for example, in an unpublished (and
perhaps never intended for publication) essay that she wrote
sometime after 1871, Nightingale lamented the extent to
which popular perception, often formed by the press, shaped
the way governments and institutions operated. She writes,
“To everybody really behind the scenes, to everybody really

interested, if any such there are, in the administering of the
Poor Law, the Indian, the military affairs of an empire, it is
perfectly well known that the administration, if they still dare
to call it by that name, of our affair is now exactly like the ad-
ministration of the affairs of a periodical. (283)20
“Politics and Public Administration” also makes it clear that,

for her, real reform involved doing work in the ways that best
suited the needs of the people who were the objects of the
reform, but only after complete assessments had been taken of
both the requirements of the task to be done and the expertise
of the person(s) doing the work. Speaking of her own work up
to this point in her life, she writes:
In all the government work I have done . . . I have always

been responsible for acts as well as for opinions, that is, I not
only got up the data, statistical, administrative and practical,
brought out the evidence and, except in one instance, wrote
the reports, but I organized the standing commissions, depart-
ments or other mechanism which were to carry out the con-
clusions or recommendations or “opinions” when they were
laid down. The reason why royal commissions are become a
sham and a stone of offence is that they don’t do this. They
simply report. . . . (CW 5: 281)
The accusation she makes here that government commissions

simply “report” on social problems without doing the neces-
sary work to establish their own expertise on the subject reflects
Nightingale’s awareness of how such cursory government effort
would help to trivialize the public’s perception of the scope

and seriousness of the issues. Often such reports simply turned
the public’s attention to a single compelling story without
providing an accurate sense of the context out of which the
issue appeared. One salient example came from the tragic and
widely circulated stories of the deaths first of the workhouse
casual, Timothy Daly, in 1864 at the Holborn Workhouse in
London, and then of a second casual soon after at St. Giles and
St George Workhouse in 1865. This death was a catalyst for
Nightingale and others to participate in producing a series of
three articles in the medical journal The Lancet. In a letter to
a friend, Nightingale writes of her hope that the story of the
pauper’s death would help them to get the trained nurses into
the workhouse infirmary, rather than leaving the care of pau-
pers to “pauper nurses,” untrained women hired from among
the pauper population to carry slops, empty bedpans, etc.. The
Lancet articles themselves, to her disappointment, produced
little such public agitation. And yet, according to Koven, when
Frederick Greenwood read them, he began to encourage his
brother, James, to write his stories of living disguised as a work-
house pauper. As we have seen, these stories caught fire in the
public imagination and sparked the trend in workhouse visitors
discussed above. The trend was reproduced in novels and on
the stage in popular melodramas.21 Greenwood’s sensational
articles, far more than Nightingale, Mill, and others’ more
“scientific” studies and reform agitation, appears ultimately to
have spurred widespread popular and governmental thinking
about workhouse conditions, but not in the ways Nightingale
thought best for actually doing something constructive about
the underlying causes of pauperism.
Nightingale would, of course, recognize the benefits of
the raised public awareness of workhouse conditions caused
by the sensational stories Greenwood’s essays prompted. But
what was done with such awareness by government officials,
who she felt ought to be guiding reform efforts, was deeply
disappointing to her. In “Politics and Public Administration”
she writes, “In these days of superficial discussion,” politi-
cians, including “even the cabinet,” “get up a subject, whether
On Giv ing 55
a pauper or an ironclad, whether an Army or a colony, from

reading, calling for reports and statistics, as people get up lead-
ing articles of periodicals and they call that administration.
Ten years ago we did the things people now talk about, write
about, debate about, report about” (CW 5: 282). Just as she
objected to female philanthropists’ scattershot efforts to help
the poor, sick, and aged, she also rebuked the government for
not dealing with the problems created by the New Poor Law
in a systematic, “scientific,” and even idealistic way.
Governments, she felt, had the vital role in creating for the
public an ideal for their society and a means of determining
how to bring their society to that ideal. “Above all it is gov-
ernments that dispose of life. Is it not then, the first, the most
important step to have a political science, to raise it, if it is a
science, into an exact science?” (CW 1: 62).22 For Nightingale
“science” and “scientific” research most often meant “statis-
tical” research. And just as she felt that God shows us how to
prevent the occurrence of epidemic disease via sanitary statis-
tics, as discussed in chapter 2, she believed equally strongly
that God also provided governments with the ability to pre-
vent poverty, illness, and the like through “scientific” study of
the social, moral, and material conditions that produce pov-
erty. What such expertise offered was a way to discover sound
scientific bases for governance; but because of the statisticians’
attention to the evidence of God’s laws, this expertise also
offered a means for the government to provide sound moral
guidance as well. Anything other than a striving toward such
scientific and moral expertise was in her view irresponsible
governance.
In letters and unpublished essays throughout her career, she
complained that governments did not work toward the kind of
scientific and moral expertise she advocated and she opposes
her ideal of government to the workings of charitable societies.
In “Politics and Public Administration,” she writes,
What is the type of national prosperity in Mr Gladstone’s

mind, Mr Lowe’s, Lord Overstone’s. 23 Is it our workhouses,
our pauperism returns? Is it our national credit upon which
they can borrow? Have they any type? Do they think God like
a charitable society, doing a little good to this individual and
to that and not a little harm, without any type in his mind
as to bringing people out of pauperism and dependence into
independence and self support? That is the common notion
of God.
Nightingale’s idea that government can and should dis-

cover its “ideal type” is one she began developing long be-
fore her Crimean work and one she sustained and adapted
throughout her life. For example, Suggestions for Thought
among the Artizans of England, a book she composed largely
prior to her departure for the Crimea in 1854, reveals how
Nightingale’s spiritual and philosophical views influenced
her approach to public policy about poverty and disease. She
self published only 6 copies of Suggestions in 1860 and sent
them to John Stuart Mill, Benjamin Jowett, John McNeil,
and others whose philosophical, religious, and political views
she respected. Speaking of the “governing power” of a Perfect
God, Nightingale explains the link she sees between God’s
government and human government:
Observation, extending throughout the phenomena of nature,

present and past, is presenting to us teachings of another kind,
a governing power of another kind [God’s]. A government is
good in proportion as it offers means and inducement to a
man to realize for himself and for his kind a state of being
appropriate or befitting to human nature; that is to say, a state
of being in harmony with (or adapted to) its present type, but
ever progressing towards a higher type. What this higher type is
we do not yet know definitely. But we do know, by experience,
the capability of human nature for indefinite improvement.24
We can recognize here the influence of the German idealism of

Georg Wilhelm Friedrich Hegel which Thomas Carlyle helped
to disseminate in England particularly in Sartor Resartus and
which Alfred Lord Tennyson drew from in his exquisite collec-
tion of lyrics devoted to his late friend Arthur Henry Hallam,
On Giv ing 57
“In Memoriam, A. H. H.”25 Nightingale, however, concerns

herself less with the individual’s role in producing or repre-
senting the moral and scientific progress of the species and
more with asserting that it is governments who should “real-
ize” for their people not only what “the present form of the
state of being is,” but what it ideally ought to be. Humans as a
type are entirely capable of improvement, she appears to think,
but only if provided by their government (and others with the
power to influence public perception, such as the press) with
an ideal vision to which they should aspire.
Workhouse administration provided for Nightingale a key
example of the failure of government to think with this kind
of moral vision of what type of society its economic and social
policies would produce. Its failures for her were reflected in
everything from the lamentable “workhouse test” (by which
people’s ability to support themselves alone determined
whether or not they would be thrown in a workhouse), to the
failure of workhouse officials to distinguish within the work-
house population between the able-bodied poor and the sick,
aged, and mentally ill among them, to the tending of work-
house infirmary inmates by unskilled “pauper nurses” rather
than skilled nurses.
Nightingale’s views about Poor Law reform combine what
might seem to be two quite different priorities. She wanted
to promote measures that would develop the pauper’s abil-
ity to achieve individual economic independence by providing
him or her with education and the opportunity to be paid a
living wage for his or her work, something she felt the pau-
perizing effects of the New Poor Law did not allow for. This
first priority might seem to be at odds with her second pri-
ority: the need for idealistic forms of governance based on
“scientific,” statistical study of the state of the social body.
The proto-sociological method of such study would appear to
be more in keeping with a big government, big bureaucracy
approach to governance more typical of European govern-
ments of the time. Lauren Goodlad follows theorists such as
Mary Poovey and others in identifying in mid-Victorian liber-
alism a paradox between the desire for such stronger forms of
government—which Goodlad and Poovey both identify par-

ticularly with the sanitary movement spearheaded by Edwin
Chadwick and the New Poor Law—and the priority British
society, as opposed to other European societies, placed on fos-
tering a sense of individualism in its population. Nightingale
would seem to be suggesting her preference for the latter when
she describes the examples of Thomas Chalmers, George
Muller and Roman Catholic societies that do “their voluntary
part of Poor Law work with more Christianity and economy
than the [Poor Law] guardians themselves” (135).
Several facts about Nightingale would seem to support the
association that is consistently made between her reform work
and ideas of big government and big bureaucracy. The claim
made by Elizabeth Gaskell and even her own sister Parthenope
that Nightingale cared “only for institutions” and not for
individuals, seems to dovetail with the fact that she consis-
tently pushed for statistical studies of health, poverty, and the
like and thus her work on sanitary reform was often associated
with the work of other sanitary reformers, such as Chadwick.
But, as we’ll see, Nightingale’s views about reform, statistics,
health, and poverty developed in different ways to those of
Chadwick’s.
Nightingale’s particular views gave her a way to sustain
both her priorities (bureaucratic, statistical study of aggregate
populations and social reforms designed to bring about indi-
vidual fulfillment) without having to see them as functioning
paradoxically. Her belief was that a benevolent “perfect God”
provides evidence of how governments might learn the ideal
form of their society and in turn, through that effort to con-
vert their society to that ideal form, governments would then
show individuals how to make of themselves ideal “types” of
people.
These views developed in part from her reading of Adolphe
Quetelet. In an essay she began sometime around 1851–
1852 and finished around 1874, Nightingale describes how
Quetelet’s ideas help her to connect the idea of laws in nature
to intellectual and moral qualities. After a brief explanation of
Quetelet’s idea of a human type called a “mean man” from his
On Giv ing 59
Physique Social, Nightingale extrapolates from his theory in

the following passage:
Human heights, then, so far from being accidental, regis-

ter laws the most exact, calculable before hand to a regular
curve and observable to tally with this curve. So with human
weights, so human strength, quickness, etc. So, Quetelet
believes, but had not fully worked out the problem, with int-
ellectual and moral qualities. This, as he says, is one of the
most admirable laws of creation. All is under God; nothing is
accidental. The observed facts of nature are reduced to numer-
ical calculation. . . . This is a law: a law does not “govern” or
“subordinate,” does not compel people to commit crime or
suicide. On the contrary, it puts means into our hands to pre-
vent them, if we did but observe and use these means. It sim-
ply reduces to calculation observed facts. This is all that a law
means. (CW 5: 47)
In this same document Nightingale anticipates the objections

of those who might claim that social factors were too complex,
dynamic, and unpredictable to be subject to laws in the same
way naturally occurring phenomena could be seen to follow
laws of nature. For Nightingale,
These laws or results change, of course, with the causes which

give them birth, for example, civilization, sanitary and moral,
changes the law of mortality by diminishing the death rate. So
it is with the law of morality. The causes influencing the social
system are to be recognized and modified. From the past we
may predict the future. Let us no longer act empirically in our
legislation, in our philanthropy, in our government, but let us
study and learn these laws. (CW 5: 47–48)
While causes affecting human behavior might change, she

argued, the “[w]ills and inclinations of men and women will
be the same, the same causes acting” (48). Accounting for the
kinds of changes that made differences in the ways that social
laws functioned drew Nightingale back to her considerations
of the press and its negative effects on moral governance. In
this excerpt from the same essay quoted above, Nightingale

returns to the Plato’s Republic to explain her view.
Of these “powers” [that influence social factors] one would

undoubtedly say in this day is the press. Is it, as Plato would
say—only he calls the press by the name of “sophists”—is it
only the “representative” of this world’s influences, of party,
of society? Is it not the “corruptor” of the world/society, but
is it the leader of public opinion? Or does it only tell us what
men say? Does it only “give back to the world their own opin-
ions?,” “make public opinion the test of truth?” (Republic).
(CW 5: 49)
For her both governments and the press can influence pos-
itively or negatively the ways social laws work. This under-
standing fueled her sense of the vital importance of the
Government acting with a “scientific” understanding of
God’s laws in the social field. In her own words, “How great
the importance then of a statesmen studying these laws [of
social behavior], Parliaments or powers which can gradually
change those conditions of society of which these laws are the
product” (CW 5: 48).
Nightingale’s Public Writings on

Workhouse Reform
As one might expect, given her acute awareness of how the
press influenced public opinion on issues of reform and phi-
lanthropy, there is a noticeable difference between the views
Nightingale expressed in her private and unpublished writ-
ings discussed above, and the articulation of such views
in her published work related to workhouse reform. In
Nightingale’s widely circulated essay on workhouse reform,
“A Note on Pauperism,” published in Fraser’s magazine in
March 1869 she begins not with an accounting of the policy’s
lack of moral vision that she espoused in private works, but by
appealing to readers’ concerns about the material conditions
produced by the policy. The essay begins by informing her
On Giv ing 61
Fraser’s readers:
“Seven millions of pounds are spent annually in this great

London of ours in relief, Poor Law, and charitable.” And with
what result? To increase directly and indirectly the pauperism
which it is meant to relieve. Pauperism in London has doubled
in the last ten years.26
In a draft memorandum for a public policy statement on the

same subject Nightingale even suggested that the government
take the enormous step of eliminating the workhouse alto-
gether by “converting all paupers into outdoor recipients” as
the means to “a great savings.” It is significant that, though
in her introductory gambits she justified both these argu-
ments in terms of the material benefits they would provide to
the public, Nightingale’s central objections to the workhouse
system were not about government spending, but about pro-
viding the possibility for paupers to work themselves out of
poverty. She soon replaces the emphasis she puts on public
expenses at the beginning of her essays with more complex and
human considerations. In “a Note on Pauperism” she objects
strenuously to the “Workhouse test,” first for the ways it has
produced more numbers of paupers, but shortly afterward she
explains that, “the least harm of the overflowing workhouse
is the burden on the rates” (municipal taxes). The most harm
was in stripping the poor of their ability to support them-
selves, work being “the strongest of our instincts.” “[T]he
best work the world has seen,” she argues, is “paid work.” She
introduces another section of the essay in which she identifies
those people and organizations that provide a better model of
poor relief by citing the 100,000 stray orphans in the London
streets which the Poor Law was supposed to eliminate. She
describes then quite passionately the examples of Thomas
Chalmers, George Muller and Roman Catholic societies that
in her words, did “their voluntary part of Poor Law work with
more Christianity and economy than the [Poor Law] guard-
ians themselves” (135). “Christianity and economy” might
seem to make strange bedfellows in this argument, but as
we’ve seen, for Nightingale, they went hand in hand, and one
of her central goals in her public writings appears to have been
to get the public to view them in the same way. It seems that
she hoped in time to get the public to recognize the societal
laws in which she believed, just as she had influenced so many
to follow what she believed were the laws of hygiene.
Poor Law workhouse reform, however, proved to be a par-
ticularly vexing subject for Nightingale when the objective evi-
dence she tried to produce to support her own proposals failed
her when it mattered most. To explain I need to describe the
difficult efforts of one of Nightingale’s most valued trainees,
Agnes Jones, to become the first workhouse infirmary super-
visor at the Liverpool workhouse, and then the even more
complex effort Nightingale made to extend workhouse infir-
mary nursing to London workhouses.
One of the cruelest features of the workhouse system, she
argued, was that it didn’t distinguish between the able-bodied
poor and those who were sick, aged, and mentally ill. In the
“ABCs of Workhouse Reform,” an article she presented to
Charles P. Villiers, President of the Poor Law Board (1859–
1866) in December 1865, she insisted that these populations
must be taken out from under the supervision of the work-
house supervisor, and put under the jurisdiction of a work-
house infirmary nursing supervisor. By providing professional
nurses to help cure these sick, rather than the pauper nurses
currently working in the infirmaries, Nightingale argued that
entire families could be kept from pauperism. Nightingale’s
favorite trainee, Agnes Jones, agreed to be the first work-
house infirmary supervisor offering trained nursing to all its
residents. Jones labored under incredibly difficult circum-
stances; her role as nurse supervisor was often disrespected
by workhouse administration and staff.27 Nonetheless, Jones
persevered.
Nightingale hoped that they would be able to extend the
Liverpool Workhouse Infirmary experiment to London. But
when workhouse supervisor Villiers came to Nightingale look-
ing for the empirical evidence of the success of the Liverpool
workhouse nursing experiment, the statistics for 1866 and
On Giv ing 63
1867 revealed no significant difference in the recovery rate

of patients with trained nurses to those with pauper nurses.
Nightingale lamented to a friend, “With reference to the sta-
tistics I cannot help feeling that much injury has been done to
the cause by putting forward figures at all as a test of nursing
efficiency” (CW 6: 273). Nightingale faulted the irresponsible
way that the workhouse kept the statistics only of the survival
rates of patients in trained nurse wards versus pauper nurse
wards, without reference to the severity of the sick cases going
in and other environmental factors. In the “Liverpool case”
she argued, the statistics “represent nothing because they have
never been kept with reference to any result” (CW 6: 273).
The narrative of failure that the statistics appeared to support
was indeed generated from facts, but facts without reference
to critical individual details. The only comfort to Nightingale
was anecdotal with Villiers citing that patients in the trained
nurses program had been observed to be happier than in the
wards staffed by pauper nurses.
At about the same time, the planned expansion of the
trained nurses’ experiment from Liverpool to London was in
terrible jeopardy. Nightingale knew that they were desperately
short of nurse trainees of Jones’s caliber capable of direct-
ing nursing in the workhouse. Jones herself died suddenly of
typhus in February 1868. Following her death, there was pro-
found disagreement between Nightingale and Jones’s family
about the best way to memorialize her. The family published a
book of memoirs that included narratives claiming that Jones
had literally performed miracles in her work.28 Nightingale
was horrified. In response, Nightingale published her own
eulogy for Jones called “Una and the Lion,” in Good Words
on June 2, 1868 detailing the self-sacrificing efforts of her
heroine to heal the workhouse inmates and save their families
from pauperism.
The name Nightingale chose for her narrative about Jones,
Una, of course alludes to the Una of Edmund Spenser’s epic
poem, The Fairie Queen. Only in Nightingale’s story, Una,
who stands for “truth” and true Christianity, takes on the cen-
tral role of hero. Nightingale used this story of female heroism
with its powerful literary allusions to encourage female readers

to train to become nurses. As Lynn McDonald notes “Una
and the Lion” was wildly popular and went through four-
teen editions in England and the US, even prompting a sym-
pathetic letter from Harriet Beecher Stowe. Perhaps more
importantly, the article, which gave details about where aspir-
ing nurse trainees might apply helped to elicit “many more
applications than was usual” (CW 6: 279). In the face of losing
the possibility of expanding workhouse nursing because of a
lack of interest, and in the absence of statistical data to support
her claims about the need for employing trained nurses in the
workhouse, Nightingale’s richly detailed, idealistic narrative
appears to have succeeded, or at least contributed importantly
to the growth of nursing in England and the spread of trained
nursing in workhouse infirmaries. (CW 6: 279–80).
A Different Kind of Philanthropy in

Narrative: Models of Heroism and
Broader Notions of “Family”
As we have seen, Nightingale’s understanding of the power
of popular narratives in the press to raise awareness of social
problems appears throughout her writings. We also see her dis-
tress that raised awareness seldom led to the kind of efficient,
morally and scientifically sound response that Nightingale
hoped for. The success of “Una and the Lion” will have con-
firmed for her that inspirational and touching stories of “nor-
mal” people—and not just statistical and sensational reporting
about current events and celebrities—had the ability to influ-
ence the social field in positive ways. They might provide
models for how individuals with the desire to help bring about
social change could participate in bringing about that change
in ways appropriate to their own social conditions.
Among the books Nightingale bought to donate to sol-
diers, nurses, and other charities, Nightingale chose biogra-
phies of female social reformers who she felt did their work
in an educated, self-sacrificing, and utterly committed fash-
ion. In addition to Agnes Jones’s biography, she bought those
On Giv ing 65
of Octavia Hill, advocate for housing reforms benefiting the

poor and Mary Carpenter, who pushed for educational and
penal reforms in Britain and India. Nightingale also donated
the works of Caroline Chisholm who supported emigration
as a strategy to reduce pauperism. These were all causes about
which Nightingale wrote approvingly.
An avid reader of the classics—at the very least she knew
Greek, Latin, French, German, Italian—as well as actively fol-
lowing government reports, and current novels, Nightingale
chose with some care the current fiction which she donated
to charities. These works, too, appear to have been selected by
her not just on the basis of the kinds of values each work repre-
sented, but also the examples of beneficial and practical work
toward solving social problems that each text offered. While
Nightingale donated to charity the works of many writers over
her lifetime, I concentrate in what follows on her interest in
two particular authors’ works to explain how they illustrated
in a positive way the kinds of societal ideals that Nightingale
endorsed in her own writings.
Nightingale was an enormous fan of Dickens, quoted him
regularly in her correspondence, and had been on the receiv-
ing end of his philanthropy. She also worked with him when
she joined forces with the Committee of the Association for
Improving Workhouse Infirmaries, on which he and John
Stuart Mill served. Her admiration for Dickens was not lim-
ited to the exposure he brought to the social problems expe-
rienced by the poor, sick, and aged. His humor suited her
witty, vibrant personality. She loved, for example, to quote
“Barkus is Willing” from David Copperfield whenever agree-
ing to do something she didn’t want to do (CW 5: 767). At
various times, she donated the Christmas Books, Oliver Twist,
Bleak House, Barnaby Rudge, Little Dorrit, Dombey and Son,
Nicholas Nickleby, Martin Chuzzlewitt, David Copperfield, and
the Pickwick Papers to the various soldiers, nurses, and other
charitable institutions to whom she regularly sent books.29
Dickens’s skewering of female philanthropists in Bleak
House would seem in accord with Nightingale’s own views of
the same women as “wanting in earnestness,” as expressed
to Lady Eastlake. Dickens’s characterizations, already noted

above, of Mrs. Jellyby’s telescopic philanthropy that ignores
domestic problems in the interests of her philanthropic work
for the Borrioboola-gha, and Mrs. Pardiggle’s more militant
and invasive model of charity home visiting have their coun-
terexample in Esther’s more appropriate notions of her “circle
of duty” derived initially from her sympathy with the needs of
the poor. Here Esther’s efforts to explain to Mrs. Pardiggle
her objections to participating in the kind of bullying home
visiting Mrs. Pardiggle practices provide a powerful sense of
Dickens’s views of the appropriate attitudes and education that
should be prerequisites for participation in philanthropy:
At first I tried to excuse myself for the present on the general

ground of having occupations to attend to which I must not
neglect. But as this was an ineffectual protest, I then said, more
particularly, that I was not sure of my qualifications. That I
was inexperienced in the art of adapting my mind to minds
very differently situated, and addressing them from suitable
points of view. That I had not that delicate knowledge of the
heart which must be essential to such a work. That I had much
to learn, myself, before I could teach others, and that I could
not confide in my good intentions alone. For these reasons I
thought it best to be as useful as I could, and to render what
kind services I could to those immediately about me, and to
try to let that circle of duty gradually and naturally expand
itself. (Chapter 8)
This “circle of duty” that Esther imagines as “gradually and

naturally” expanding from the local people she knows to the
larger community is the conceptual approach that allows Esther
to enter a poor brick layer’s house and offer appropriate help
and comfort to the family without condescension or disrup-
tion. Equally important is Esther’s awareness that the kind of
work Mrs. Pardiggle presumes to do involves a skill in “adapt-
ing” to “minds . . . differently situated” and that expertise in
such work does not come simply through “good intentions”
but through sustained commitment and familiarity with the
On Giv ing 67
lives and social conditions of those to whom care is offered.

Esther’s words sound quite similar to Nightingale’s beliefs
about training nurses. She would likely have found Esther’s
model of home visiting an appropriate, morally and physi-
cally healthy example of how reform should work. Indeed the
training of district nurses involved just such efforts to prepare
nurses for the social conditions and the people they would
meet as part of their work.
Though Nightingale bought Bleak House for charities, she
was pained by one aspect of Dickens’s satire. She recognized
Dickens’s hyperbolic portrait of Mrs. Jellyby as an attack on
the work of Victorian female emigration activist, Caroline
Chisholm, a respected friend of Nightingale’s whom she
defended in letters after reading Bleak House, as one entirely
devoted to bettering the lives of others at great expense to
herself. Nightingale also supported emigration as a way for
those without other means to bring themselves out of pov-
erty. Writing to an unknown correspondent, Nightingale says
of the “East End Emigration fund,” that its work had “by
migration and emigration, provided permanent employment
for about 1750 poor persons, of the most unpromising mate-
rial, nearly all of whom are doing well and this at a cost of less
than ₤4 per head” (202). But, Nightingale objected to the
idea of emigration being promoted to the able-bodied, poor—
those who showed the “promise” (unlike those mentioned in
the quote above) of succeeding through hard work in Britain.
In a letter to her friend, John McNeill, on the subject of emi-
gration, Nightingale expresses this view:
I confess, though I have always tried to help as far as I could,

those fine fellows among the unemployed workmen who will
pinch and pawn to help themselves out, and afterwards their
families, to the colonies, that I think these are the men whom
we should the least wish to part with. . . . It is the orphan and
deserted children who can’t help themselves, the young girls,
not yet vicious, who are as it were predestined to sin and pau-
perism in the old country, who might be good and industrious
and happy in the new.30
Dickens’s representations of emigration seem to have more in

common with Nightingale’s views than his satire of Caroline
Chisholm did. For example, the villain Tom Gradgrind emi-
grates to America in disgrace at the end of Hard Times. And
in David Copperfield, Dickens famously has his comical and
pathetic character Wilkins Micawber—who can’t stay out of
debt while living on British soil—become a successful mag-
istrate and bank manager after his emigration to Australia.
Even Little Em’ly, though “ruined” in English society by
David Copperfield’s friend Steerforth, too, finds redemption
of a sort in the outback.
Despite his satire of Chisholm Dickens had earlier sup-
ported her work, even collaborating with her on a “Bundle of
Emigrant’s Letters” which he published in the first issues of
his journal Household Words. In his work with Angela Burdett
Coutts at Urania Cottage, an institution dedicated to reclaim-
ing the lives of “fallen” young women and training them for
emigration to the colonies, Dickens showed a similar interest
to Nightingale’s in sending off those women who, though
fallen, were not yet considered entirely wicked.31
Dickens’s fiction plays out his views on the benefits of emi-
gration for some. As Nightingale would have had it too, in
Dickens’s novels the able-bodied, intelligent, and (in the case
of female characters) “unfallen” stay in England and contribute
to their communities. Dickens does not have his heroine Esther
Summerson and her husband emigrate away from England at
the end of Bleak House, as many condition of England novels
did with their middle and lower class heroes and heroines.32
Instead Esther and her doctor husband move to Yorkshire and
work for their community, acting out the “circle of duty” idea
Esther had articulated to Mrs. Pardiggle. Though as usual in
Esther’s narrative, we only see Esther’s role in the care of com-
munity as reflected in her accounts of how others respond to
her (seemingly without her awareness of having deserved their
admiration), it is clear that Dickens wishes us to see Esther and
Woodcourt’s primary role not as parents (in the novel’s final
chapter Esther mentions the existence of their two daughters
only briefly and almost as an afterthought), but as caregivers
On Giv ing 69
and moral exemplars to their community:
We are not rich in the bank, but we have always prospered, and
we have quite enough. I never lie down at night, but I know
that in the course of the day he has alleviated pain and soothed
some fellow-creature in the time of need. I know that from the
beds of those who were past recovery, thanks have often, often
gone up, in the last hour, for his patient ministration. Is not
this to be rich?
The people even praise me as the doctor’s wife. The people
even like me as I go about, and make so much of me that I
am quite abashed. I owe it all to him, my love, my pride! They
like me for his sake, as I do everything I do in life for his sake.
(Bleak House, Vol. 3: Ch, 67).
The transformation of Esther from illegitimate orphan to bea-

con within her community is one Dickens prepares Esther for
(and through her, the reader) throughout the novel.33 Esther
gains her expertise in the areas of “housekeeping” (eff icient
care and moral guidance within the domestic sphere, a care that
extends to the place and to all its residents) particularly when she
becomes part of the affiliative family John Jarndyce creates for
himself when he brings home to Bleak House two wards of the
court, Ada Clare and Richard Carstone, and Ada’s “compan-
ion” Esther. Esther becomes the “housekeeper” and “Mother
Hubbard” to all the residents of Bleak House when Jarndyce
gives her the housekeeping keys. Esther’s frequent practice of
nervously jiggling her housekeeping keys in moments in which
her identity, attractiveness, and worth are challenged signals
the association Dickens makes between Esther’s role within the
home and her psychic well being. Esther, not Jarndyce, runs
Bleak House and is the primary confidant and caregiver to its
residents. Jarndyce’s inability to provide the benefits of an affili-
ative family without Esther are evident in his “adoption” of the
self-proclaimed “child” Harold Skimpole, whose entirely selfish
actions participate in the destruction of Richard.
Much has been written about the broken and dysfunctional
families that populate Dickens’s novels. Some of the affiliative
families that appear in his novels show the potential for the
exploitation of the children who become part of them, per-
haps most notably the “family” Fagin creates for himself out
of the pickpockets and prostitutes he adopts and trains in
Oliver Twist. But Dickens also creates affiliative families who,
in the wake of families broken by poverty, crime, moral fail-
ing, etc, fulfill the necessary role of providing material and
moral support and guidance to those without resources to
take care of themselves. With Esther, Jarndyce creates that
kind of family.
Nightingale’s writings about Poor Law reform show her
own faith in the power of affiliative families to perform the
work of de-pauperizing children by providing them with an
education, and by offering examples of how to live in ways that
foster independence:
Large union schools do not, however good, foster habits of

independence and frugality, de-pauperize pauper children or
fit them to make their own way in afterlife with the strug-
gles of honest men and women, but rather to return upon
the “rates,” or what is worse. “Boarding out” in picked indus-
trious families does fit pauper children to re-enter the ranks
of independence. Does this not lead us to the tail of a “law”
about “family?” (CW 5: 43)34
“Boarding out,” of course refers to the effort to place

pamper children in “industrious” affiliative families, a
strategy Nightingale clearly endorsed. But Nightingale too
was entirely cognizant of the damaging affects that both bio-
logical and affiliative families might have on their members if
the appropriate guidance and example were not provided:
Where the “family” develops good and active qualities of

mind, heart and soul, independence, industry, foresight and
self-reliance of man and woman, affection and self-denial in
each and every member, the “family” is doing its work; it is
answering its end. But where it crushes these qualities, where
it enervates, where it checks the right development and use
On Giv ing 71
of every faculty in any one member, it is not a family; it is a

thumbscrew[.] (CW 5: 45)
Of course Nightingale’s own deep ambivalence about her own

family’s treatment of her can be read into these comments. But
Nightingale did not throw out the idea of family as a model
for reform; she suggested an ideal for it and promoted it, as
Dickens did, in her writings and in the writings of those writ-
ers she admired.
Affiliative families and emigration feature as well in the
fiction of Hesba Stretton, whose work Dickens published
in Household Words and whose many books Nightingale
donated to charitable institutions.35 I focus here particularly
on Stretton’s short novel, Bede’s Charity,36 which shows com-
peting models of charity in its depictions of both the charity
that its heroine, Margary Beade, receives and that which she
provides to others among her poor neighbors. Margery Beade
(spelt with an A unlike the Bede of the novel’s title) devotes
her own life to creating opportunities for others not only to
prosper, but to bring moral stewardship to people who lack
such positive (British, middle-class) influences. Born into a
poor rural farm family, Margery forgoes marriage and takes
on men’s physically demanding farm work so that her brother
Stephen can be brought up with the education of a gentleman.
The book opens with Stephen leaving for Australia to make his
fortune—determined to return a rich man and then to prove
himself a gentleman and a descendent of the Bedes, the old
established family to whom he is sure he must belong. Shortly
after Stephen’s departure Stephen and Margery’s father dies,
which precipitates Margery’s move to London where her
generous behavior wins her the love and admiration of her
previously self-professed woman-hating, London uncle. Here
Margery also creates for herself an affiliative family when she
begins educating an orphan boy from the streets, Cor, and an
almshouse girl, Phoebe.
Margery serves these three until her uncle’s death, her
advanced age and disability lead her to become dependent
on “Bede’s Charity”—a fund exclusively for the widows of
freeman of the Bede company. The specter of the workhouse

hangs over Margery’s story; Stretton sprinkles references to it
throughout the novel. Margery only avoids it because a good
doctor falsely claims Margery’s family relation to a freeman.
Through Bede’s charity, Margery is provided with a clean and
well situated London flat where she can live independently
and continue to help in the fostering of Cor and Phoebe. By
having Margery cast out of her home, when the good doc-
tor’s falsification of Margery’s identity is discovered, and thus
throwing Margery, Cor, and Phoebe as well into increasingly
dire straits, Stretton shows the injustice of charity that selects
on the basis of blood, rather than good works and industry.
Stephen, of course, turns up in London a wealthy mar-
ried man who has claimed to belong to a noble family and
thus feels he must deny his sister’s identity. The lies Stephen
tells to his wife contrast directly with parallel instances where
Margery refuses to lie, despite knowing the devastating con-
sequences she will face for her honesty. Her refusal to deny
her own name, Margery Beade, appears at first to cost her
terribly at two key moments: first, it loses her the pension
from Bede’s charity and second, it almost loses her a coveted
bed in a shelter on a night in which she is close to death. And
yet the same events ultimately and ironically lead to her happy
reunion with Stephen, as well as an unexpected, modest family
inheritance. Her narrative concludes with her description of
how her surrogate family, Cor—now a doctor—and Phoebe,
now Cor’s wife, continue her example of aiding others by
committing themselves regularly to walk the poorest London
streets at night and find shelter for those in need, in order,
as Phoebe tells her, “to make up for the night you spent out
of doors.”
Though Stretton does not resist the common nineteenth-
century surprise inheritance plot for the deserving heroine,
Stretton nevertheless makes clear that the charity Margery
provided in seeing to the education of Cor and Phoebe, as
well as Stephen, is ultimately what leads to the reward of her
secure family life and ever-expanding model of influence.
On Giv ing 73
Margery Beade’s influence works in her narrative as Esther

Summerson’s does in Bleak House as an ever-expanding circle
of duty and moral guidance. Cor and Phoebe become beacons
of their working-class community just as Esther and her doc-
tor husband become beacons of theirs.
That Nightingale saw Stretton’s works as providing both
touching and “true” pictures of the heroism of typical chil-
dren and adults who care for the members of their communi-
ties is evident in her November 3, 1883 description of another
of Stretton’s novels, A Thorny Path (1879). In it, an old man
and his granddaughter, Dot, having been abandoned in a
London park by the girl’s mother, are rescued from the streets
by a street waif named Don, who takes them to the home of a
kindly neighbor, Mrs. Clack, where they receive shelter. After a
series of tragic events including the death of Dot’s grandfather
and Don’s false assumption that Mrs. Clack has died of fever,
Don starves himself to death attempting to save his “sister”
Dot. Nightingale’s commentary on the novel is revealing:
A Thorny Path: this is the book of Hesba Stretton’s which we

were talking about[.] . . . I never feel as if these waifs and strays
like Don were God forsaken. On the contrary, both in India
and England we find the most heroic self-devotion among
them, far more than among the educated and prosperous.
Another thing that strikes one as so true in this true story is
the uses to which the cruel mistake under which Don suffered
were put in calling forth heroism and goodness like Christ’s.
Mistakes have been most potent levers to righteousness.37
As will become increasingly evident when I turn to Nightingale’s

work on India in chapter 4, Nightingale found in such “true”
stories of typical people among the urban poor doing heroic
things narratives inspirational enough that, where facts and
statistics failed, they might turn the public in the direction of
her moral and practical views.
In an annotation to a list of Stretton’s works, Nightingale
said of Stretton’s large corpus of works “I have used all but
6 or 7 and like them very much.” Though I do not know

and may never know to what specific “uses” she put them,
it doesn’t surprise me that she found them not just enjoy-
able, but useful. I think they provided for her models of the
kinds of attitudes and behaviors that might spark the kind
of idealistic thinking that would work to reform a society
not accustomed to acknowledging female moral governance
in the public sphere.
Chapter 3
C om pe t i ng Visions: Nigh t i ng a l e ,
E l io t, a n d Vic t or i a n H e a lt h
R e for m
B y 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,1 Elizabeth Gaskell,
and philanthropist Angela Burdett-Coutts,2 had offered their
support to Nightingale’s reform efforts by helping to find
resources for soldiers, to retrain manufacturing women to be
nurses, and (in Martineau’s case), using Nightingale’s sanitary
statistics and documents about training the military in san-
itary principles to write editorials favorable to Nightingale’s
views in popular periodicals, such as the Daily News.3
There were three types of reforms; however, that
Nightingale was (perhaps surprisingly) reluctant to get behind
publicly despite the urgings of some of her prominent female
(and male) reformer friends. She resisted endorsing the three
following initiatives: advocating for women’s suffrage, open-

ing 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 sti-
fling 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 lives 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 pro-
voked in Nightingale by a novelist whose prolific intellect and
genius for realist description had earned the kind of respect
among Victorian intellectuals reserved for only a handful
of Victorian writers, including Nightingale herself. George
Eliot’s method of representing her fictional worlds according
to her dazzlingly wide-ranging reading in the works of her
scientific, medical, and philosophical contemporaries was par-
ticularly 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
philosophical 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
Competing Visions 77
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 hus-
band Will Ladislaw. In a published essay on religion and lack of
idealism in English contemporary culture, Nightingale wrote
that despite being a “novel of genius,” the ultimate effects
of the novel, particularly on the young, were terrible: “It is
past telling what harm is done in thus putting down youthful
ideals. There are few indeed to end with—even without such
a gratuitous impulse as this to end them” (Nightingale, “A
Note,” 567). The counter-example to Dorothea’s failed ide-
alism that Nightingale offers is Octavia Hill, whose contribu-
tions to society Nightingale describes as follows:
Yet close at hand, in actual life, was another woman, an ide-

alist too, and if we mistake not a connection of the author’s
who has managed to make her ideal very real indeed. By taking
charge of blocks of buildings in poorest London, while making
herself the rent collector, she found work for those who could
not find work for themselves. She organized a system of visi-
tors, real visitors, and of referees, real referees, thus obtaining
actual insight into the moral or immoral, industrial or non-
industrial, conduct of those who seemed past helping except in
the workhouse. She brought sympathy and education to bear
from individual to individual, not by ruling of committee, but
by personal acquaintance, utilizing the committee-relief as
had never been done before, and thus initiated a process of de-
pauperization so that one might be tempted to say, were there
one such woman with power to direct the flow of volunteer
help, nearly everywhere running to waste, in every street of
London’s East End, almost might the East End be persuaded
to become Christian. (CW 6: 13)
Nightingale’s repetition of the words “actual” and “real”

throughout this description seems almost hysterically to
remind the reader of the fictional nature of Eliot’s story of
“the putting down of youthful ideals.”
But why Middlemarch should have irritated Nightingale so
much is still a bit of a puzzle. Octavia Hill, the “real” woman
to whom Nightingale alludes, shared Dorothea’s interest

in providing adequate housing for the poor and appears to
share something of Dorothea’s strategies for bringing about
her plans. Certainly Dorothea gets her cottages built and in
various ways positively affects the lives of others in the novel
more by bringing “Sympathy and education to bear from indi-
vidual to individual,” than “by ruling of committee.” Caleb
Garth, who builds the cottages, and Sir James Chettham, who
consents first to have them built on his property both act in
part out of respect and sympathy with the benevolent wishes
of Dorothea. While Nightingale may simply have objected to
Eliot’s decision not to make a full-fledged, heroic and self-
sacrificing social reformer out of Dorothea, I am convinced
that her excessive distaste for the novel—in a note to her father,
for instance, she described the novel as “odious reading”—had
much more powerful, if unacknowledged, roots.
The virulence of Nightingale’s objections to the novel is
more apparent in her private, hand-written annotations to her
friend, Benjamin Jowett’s translations of Plato’s Phaedrus,4
and in his request in a letter that she leave off criticizing
Middlemarch.5 Nightingale describes the novel in similar
terms to those she used in her public essay, but her explanation
of her distress with the novel here is more pointedly connected
to her own reform efforts:
He [Socrates] has got weary and impatient, oh so weary (as I

do especially with the government, with the India government
more especially), of seeing people thinking that they have done
something when they have written down something, instead of
DOING it. . . . I do sympathize with Christ and Socrates about
writing when I see all that mass, all that stifling, choking, dust
heap of government minutes, of reviews, magazines, essays,
newspapers, reviews of reviews, novels, fiction, verses, without
one gleam of the ideal in them, without one ghost of an honest
aspiration, nay stifling all aspiration[.] . . . I think Middlemarch
beats all in this line that ever was penned because it states (toti-
dem verbis [in so many words]) that its object is to pronounce
aspiration impossible and that, because women can’t now be
Antigones and St Teresas, therefore they must marry two men,
an uncle and nephew, one an imposter, the other a Cluricaune,

within a year. The woman can look abroad over the wilderness
of London where we are crying, imploring, stretching out our
hands, advertising for women to come and help us! And write
that! Her husband’s son married Octavia Hill’s sister, and she
can coolly sit down and write that!! If we could prosecute her,
but there is no legal punishment hard enough. (CW 5: 586)6
Here, Nightingale connects her distress with Eliot’s represen-

tation of Dorothea’s fate to her “wear[iness]” and frustration
with her contemporaries for their failure to move beyond writ-
ing to action—to get governments to make changes in social
policy as she did, for instance—and for their inability to put
forward ideals to which government and the public might as-
pire. I described in chapter 2 Nightingale’s express conviction
about the need for writers, government officials, and others
with the capability of influencing social policy to express clear
ideals for governance, as well as individual and social behavior,
in order to direct the aspirations of individuals and institu-
tions in positive directions.
But the roots of Nightingale’s excessive distress with
Middlemarch probably lie much deeper than Dorothea’s
failure to imagine and act on reformist ideals. In its narratives
of the declining happiness of Tertius Lydgate in marriage and
vocation and Dorothea’s failure to find a vocation anywhere
but in marriage, Middlemarch (however indirectly) comments
critically on many of the principles that Nightingale held dear:
the importance of sanitary principles to social, economic, and
health reforms, the statistical studies that she thought revealed
those sanitary principles, and the need for science and poli-
tics to subordinate theoretical speculation to fact and substi-
tute action for words.7 Eliot’s account of Dorothea’s efforts to
build cottages, and to support and influence the men around
her toward reforms, ignores discussion of sanitary principles
almost entirely. Lydgate’s new medical research into disease
and his efforts at medical reform involving the use of “com-
parative investigations” in a fever hospital and microscopy is,
if anything, even more at odds with Nightingale’s embrace
of the sanitary idea. In large part through Nightingale’s

Crimean war nursing example, sanitary training had given
nursing the credibility it had lacked and allowed for a kind
of niche through which to advocate for the professionaliza-
tion of women. Making heroes of Lydgate and Dorothea was
doubly troubling for Nightingale because Eliot had managed
somehow to make theoretical sophistication and sympathy,
but not reformist idealism, based upon what Nightingale saw
as the clear results of rigorous empirical, statistical studies, the
most important aspects of the heroism each character does
achieve within the novel.
Why Nightingale directed all her anger toward the repre-
sentation of Dorothea may well have something to do with the
intimidating amount of research Eliot did for Middlemarch,
particularly with regard to discoveries in pathological anatomy
and medical theories about disease origins and means of trans-
mission.8 Nightingale’s expertise was in sanitary science, not
medicine, and her field of activity was largely in government
and with people involved in shaping public policy. Neither
Dorothea, nor the two male visionaries in her text, Lydgate, or
politician and reformer, Ladislaw, is heading in the direction
of Nightingale’s sanitary science, despite George Eliot’s efforts
to present each as prescient in his field in the late 1820s.
Nightingale’s concerns with the novel will have gone beyond
the issue of public perceptions of women’s limited sphere of
activity to include the roles that sympathy, science, and theo-
retical speculation played in nursing and medical research. In
the plots of Tertius Lydgate and Dorothea Brooke, Eliot sug-
gested that sympathy and scientific observation work together
in the service of medical research and in urging the value to
society of making the most productive use of individual tal-
ents. Nightingale must have recognized that Eliot’s master-
piece, set back to the late 1820s and early 1830s, will have
created a perception in the public mind and in the views of
intellectual and political friends that the “cutting edge” in
diagnosing and treating disease was driven by microscopical
researches based in theoretical speculation about the nature of
disease. Eliot’s fictional doctor Lydgate represented scientific
advancement in medicine in ways that diminished the impor-

tance of sanitary science and the prioritizing of gathering facts
over working from theories. Nightingale must have realized
that this picture of scientific and moral progress would have
broad negative implications for her own efforts to suggest a
path toward scientific and moral authority for women in nurs-
ing and midwifery.
Public Perceptions: Women,

Medicine, and Vocation
Public perceptions about medical research and practice would
have a powerful effect on the way that Nightingale presented
her vision for how women might contribute to the health of
the nation. Helen Taylor, the daughter of Harriet Taylor Mill
and stepdaughter of John Stuart Mill, established a connec-
tion between medicine and women’s rights activism in an
essay in which she described medicine as a particularly apt
field for women to enter because of the necessity for the phy-
sician to feel sympathetically for patients.9 While Nightingale
had acquired fame and moral authority because of the public
perception of her sympathy for soldiers as the governing emo-
tion involved in her decision to spend her life caring for the
sick, she bristled at the idea that sympathy was thought to be
the main qualification necessary for entering the field of nurs-
ing. And yet, from Nightingale’s earliest writings through to
the end of her career, appealing to public sympathy was per-
haps the key factor in bringing about the reforms in medicine
and public policy for which she agitated. As chapter 1 made
evident, Nightingale felt that public feelings could and should
be raised in the interest of advancing the sanitary science that
she credited with saving lives. Appealing to women to lead
the way in advancing sanitary principles at home helped con-
nect sanitary science to female moral stewardship in the home.
Nightingale attempted to extend the connection between feel-
ing and sanitary science, which she had first made in Notes
on Nursing, by illustrating in later writings how assembling
facts about the health of the urban poor in England and her
colonies would ultimately benefit the health of the nation as a

whole: as sanitary conditions improved generally, so too would
public health as revealed in statistics.
When, in 1870–1871, Eliot published Middlemarch,
Nightingale was deeply involved in Poor Law workhouse
reform and sanitary reform in India. The success of her efforts
in both realms required that politicians place a high value on
sanitary science. She may well have seen the potential harm
to the sanitary movement in Eliot’s presentation of the heroic
advances in microscopy, pathological anatomy, and the bio-
chemical study of disease that Middlemarch represents. In
spite of what Nightingale felt after reading Middlemarch, Eliot
and Nightingale already knew and admired each other’s work
and had numerous intellectual and political friends in com-
mon (including—in addition to Jowett—Mill and Martineau
perhaps most notably). Neither was hostile to women’s rights
issues: both Eliot and Nightingale, apparently without hesita-
tion, signed Barbara Leigh Smith’s 1856 petition to allow mar-
ried women to, in Eliot’s words, “have legal rights to their own
earnings, as a counteractive to wife-beating and other evils.”10
In a letter to a friend describing the popularity of the petition
amongst her acquaintances and offering to help distribute the
petition for signatures, Eliot identifies Nightingale as one of
the prominent women signees.11 And yet both women hesi-
tated at first to sign on to Harriet Taylor Mill’s suffrage peti-
tion and to join the suffrage movement.
Questioning why both women would support the Married
Women’s Property petition but hesitate to join the ranks of the
suffragists led by Taylor, J. S. Mill, and others reveals some-
thing about each woman’s awareness of her own ability to
shape public perception about the issues she cared about. Eliot
may have hesitated to agitate for suffrage out of concern that
her name would prove a liability to the movement because she
lived publicly with a married man. Benjamin Jowett mentions
in a letter to Nightingale that Eliot had “told a friend of [his]
that she would like to write something special for women, but
she felt that there were certain parts of her life which disquali-
fied her” (Jowett 256–257). Like Nightingale, Eliot appears
to have seen herself as being able to contribute more effec-

tively to women’s issues from behind the scenes. And perhaps
she did: while Eliot was its assistant editor, the Westminster
Review published essays by Caroline Frances Cornwallis in
1857 about the “Capabilities and Disabilities of Women” and
advocating for women’s right to maintain the “Property of
Married Women” (Beer, George Eliot, 33).
Nightingale would have had no such possible concern about
tainting a woman’s organization with any hint of personal im-
morality. But she resisted signing a suffrage petition until the
1865 version and turned down Helen Taylor’s initial invita-
tion to join the women’s suffrage society. She relented in 1868
and joined the suffrage society, at J. S. Mill’s urging, after
Mill had graciously read and commented on her three volume
theological and philosophical work, Suggestions for Thought.
Nightingale privately published only 6 copies of the work, of
which one each went to Mill, Jowett, and others.
Historians and literary critics have suggested that
Nightingale, by contrast with Eliot, held a low opinion of
women generally, citing Nightingale’s complaint about the
restrictiveness of families in the development of young wom-
en’s abilities in “Cassandra” and her assertion in correspon-
dence that women were generally lacking in sympathy in
comparison to men. Nightingale’s own reasoning for initially
turning down Helen Taylor’s offer to join the suffrage society
warrants further consideration:
Is it possible that if woman’s suffrage is agitated as a means of

removing these evils [“existing disabilities as to property and
influence of women”], the effect may be to prolong their exis-
tence [since] . . . the social reforms needed might become [a]
matter of political partisanship[?] . . . I have been too busy for
the last fourteen years (which have never left me ten minutes
leisure, not even to be ill) to wish for a vote, to want person-
ally political influence. Indeed I have had, during the eleven
years I have been in government offices, more administrative
influence than if I had been a borough returning two MPs[.]
And if I thus egotistically draw your attention to myself, it is
only because I have no time to serve on the society you men-

tion. . . . I could not give my name without my work. This is
only personal (I am an incurable invalid). . . .
I entirely agree that “women’s political power should be direct
and open.” But I have thought that I could work better for
others, even for other women, off the stage than on it. (CW 5:
394–97)
She gives three reasons here: first, progress for the reforms
she thinks should receive the highest priority might be slowed
by agitating for women’s suffrage; second, “her administra-
tive influence” in government had been improved by her deci-
sion to work “off the stage”; and third, she did not feel she
could be a token member of an organization to which she did
not contribute her “work.” Nightingale’s reasoning thus had
partly to do with her interest in other causes: She explained
to Mill that her work was best devoted to India, Poor Law
workhouse reform, and other matters related to health policy.
Interestingly, however, she seldom took public credit for work
in these areas either, such as the enormous efforts she put
into gathering sanitary statistics in India. As the letter above
indicates, however, she suspected additionally that she could
“work better . . . even for other women” by staying behind the
scenes (1878 CW 5: 407).
Nightingale’s attitudes about women entering medicine
have been at the root of what many identify as being her anti-
feminism. In her correspondence with J. S. Mill, in particular,
she describes her aversion to women aspiring to be doctors.
But that did not mean that she did not want educated women,
such as herself, to influence medicine.
In an early abandoned draft of “Suggestions for Thought,”
which interestingly also appears to be Nightingale’s only
attempt at novel writing, Nightingale makes a connection
between medicine and women’s issues through a story about
failed vocational aspiration. The narrative begins with the
first-person narrator describing a walk that she takes with her
daughter. In the dialogue that ensues, the daughter likens her
own experience of disappointment in finding no vocation (the
experiences of “we [women] all”) to the sufferings of Christ in

the wilderness:
Have I not lived these many, many years trying to find bread
in society, in literature, the literary trifling of a civilized life,
in the charitable trifling of a benevolent life, in the selfish ele-
gance of an artistic life? Have I not . . . longed for applause and
sympathy for that which is not good—the vulgar distinction
of social praise[.] (CW 8: 113).
Seeking fame through charitable giving, or through literary or

artistic efforts is, for the daughter in Nightingale’s narrative
an empty endeavor. The daughter reserves her chief lament,
however, for her abandoned efforts to make “the great leap”—
that leap presumably having to do with entering and being
successful in the world of men.
Three times I have tried to take the great leap. Once, . . . when
I longed for a man’s education at college and thought of dis-
guising myself and going to Cambridge. Once [ . . . ] when I
endeavoured to enter a hospital to learn my profession there,
in order afterwards to teach it in a better way. And once, when
all other “trades” having failed, . . . I resolved to try marriage
with a good man, who loved me, but who would initiate me
into the regular life of the world. (CW 8: 114)
This account probably refers to Nightingale’s few months

trying to learn the practical aspects of nursing at Salisbury
hospital. Nightingale described her disappointment with the
results of her efforts in a letter to her cousin Hilary in 1845
(CW 8: 114 n. 98). Her plan, she told Hilary, was not just
to “to learn the ‘prax’,” but also to create a community of
women capable of finding in nursing a vocation:
And then I had such a fine plan[;] . . . something like a Protestant

sisterhood, without vows, for women of educated feelings,
might be established. But there have been difficulties about
my very first step, which terrified Mama. I do not mean the
physically revolting parts of a hospital, but things about the

nurses and surgeons which you may guess. (qtd. in Cook, 44)
In her imagined dialogue with a mother in her abandoned

novel, Nightingale articulates in the daughter’s voice the
effects of having had such vocational ambitions thwarted:
After reminding her mother that she gave up her ambition to
learn in the hospital because her mother “would not suffer”
her plan, she suggests the lingering pain of her loss:
The vocation was so strong in me. I had thought of it ever

since I was six years old—I might have been the Howard of
hospitals, which I mention, not, I think, from any puerile
vanity now but merely because I believe, in that case, while
the vocation would have been the angels’ wings to bear me up
and I should not have dashed my foot against the stones. Oh!
If I had done it what a different creature I shousld have been.
But you could not tell that. I do not blame.
Interestingly the mother comforts her daughter by suggest-

ing that Howard’s reforms—referring to prison reformer John
Howard—had only done so much good: “Did not the prisons
remain in the same state as they were for a century after all his
efforts?” (CW 5: 114–15). Nightingale seems to be working
through in her own mind the possibility that her success in
reforming hospitals might have been similarly limited, even if
her efforts had not been thwarted through her mother’s stan-
dards of propriety. The “change” she desires clearly refers to
the effects she would produce in hospitals by promoting san-
itary principles within the hospital, employing trained female
nurses.
Of course it is ironic that, at the very moment when she her-
self is attempting a first novel, Nightingale creates a character
that questions the value of literary and artistic success in con-
trast to the societal benefits a hospital reformer might bring
about. But, if we take seriously the idea that Nightingale’s
abandoned novel suggests, that she early on imagined her-
self as having the ability to reform hospitals as Howard had
reformed prisons (and of course her sanitary work eventually

did reform hospital construction and design), were it not for
the over-protectiveness of her mother, then we can see just
how foundational were her sanitary principles to her vision of
the possible contribution that she, and through her other edu-
cated women, might make to society—even as early as 1845,
nine years before her Crimean war exploits began.
Perhaps our recognizing Nightingale’s early aspiration to
bring about widespread reform in hospitals—and in the pro-
cess provide opportunities for professionalizing educated
women—helps make her excessive distress with Middlemarch
understandable. For Nightingale, Eliot will have told a story
that hit close to home. It involved depictions of scientific pro-
gress with regard to hospitals and social reform purportedly
drawn from reality. Moreover, Eliot created in Dorothea, and
indeed in Lydgate, characters who aspire to great, heroic lives
as reformers, but who only achieve a small measure of hero-
ism primarily through their willingness to sympathize with
others and thus see beyond the limits of self. The fact that
the limited heroism the affectionate narrator awards to each is
clearly the result of each character’s active sympathy for those
whose lives their decisions most effect, will have been painful
for Nightingale to admire.
Housing, Health, and Hospitals

Middlemarch created numerous direct challenges to the san-
itary ideal of Nightingale. First, the novel introduces its her-
oine, Dorothea Brooke, by emphasizing her desire to find a
way to do good in the world. She first imagines contribut-
ing to the public good by creating plans to provide adequate
housing for the poor who live on her uncle’s estate—a scheme
of which Nightingale would no doubt have approved. Eliot
appears at first to engage with issues of sanitation in references
to Dorothea’s scheme for cottages, but Dorothea’s pleasure in
the cottages often appears to have more to do with appearance
than salubriousness. In the many references early in the novel
to Dorothea’s cottage scheme, we learn that that Dorothea
has based her cottage planning on the ideas of John Claudius

Loudon, whose works about architecture landscape design, and
urban health were informed by miasmatic disease theories.12
As she says, “I have been examining all the plans for cottages in
Loudon’s book, and picked out what seem the best things. Oh
what a happiness it would be to set the pattern about here! I
think, instead of Lazarus at the gate, we should put the pig-sty
cottages outside the park gate” (3: 54). The picture she creates
is more one of tidying the park of unseemly poverty and sick-
ness than eradicating the sources of illness. The narrative only
enhances this picture when it describes Dorothea’s growing
excitement about the prospect of her plans coming to fruition
on her neighbor, Sir James Chettham’s property, “Dorothea
was in the best temper now. Sir James, as brother-in-law, build-
ing model cottages on his estate, and then, perhaps, others
being built at Lowick, and more and more elsewhere in imita-
tion—it would be as if the spirit of Oberlin had passed over the
parishes to make the life of poverty beautiful!”13 (3: 54). Pastor
Oberlin’s reforms, like Dorothea’s plans for reform, were based
on improving the material (and spiritual) conditions of the
poor, but were devised in the eighteenth century before sani-
tary science had taken root.
Late in the novel we learn that Dorothea has earlier con-
sulted Lydgate about her cottages and the connections they
might have to the health of their occupants. But even here
the association the novel makes between poor housing and
disease will have been troubling to Nightingale. Lydgate asks
Dorothea to help fund the fever hospital he has been run-
ning, suggesting, “I think you are generally interested in such
things, for I remember that when I first had the pleasure of
seeing you at Tipton Grange before your-marriage you were
asking me some questions about the way in which the health
of the poor was affected by their miserable housing” (44: 477).
Sanitary science may be implied here, but Lydgate’s suggestion
that Dorothea is interested in “such things generally” (encom-
passing fever research and adequate housing) will have implied
that sanitary science and the theoretical research Lydgate
does into fever are essentially one and the same thing and
not, as Nightingale viewed them, quite different approaches

to questions of public health. Nightingale thought fever hos-
pitals were a terrible idea. Writing of fever hospitals in an 1867
letter, Nightingale asserts, “The mortality of fever hospitals
has always been so enormous as to raise the gravest doubts
whether so far as concerns the interests of the sick poor, it
would not save life to abolish them and treat fever cases in
small huts” (CW 6: 415). She blamed poor sanitary practices
in fever hospitals for the high mortality rate.
Shortly after Dorothea makes some headway in bringing
her cottage scheme to fruition, theoretical research takes on
added importance in Dorothea’s vision of improving society
when she reimagines her potential contribution to the public
good as marrying an aged scholar in order to serve as secretary
to him as he works to develop a theory of the interrelationship
between a number of the world’s mythologies. Her decision to
put her life’s efforts into helping Casaubon develop his “Key
to All Mythologies,” rather than, for instance, extending her
reform efforts for the poor beyond her uncle’s and immediate
neighbors’ properties, Dorothea essentially chooses to value
the development of theories over the accomplishment of acts.
And the narrator presents that desire for overarching theory
entirely sympathetically:
For to Dorothea, after that toy-box history of the world

adapted to young ladies which had made the chief part of her
education, Mr Casaubon’s talk about his great book was full
of new vistas; and this sense of revelation, this surprise of a
nearer introduction to Stoics and Alexandrians, as people who
had ideas not totally unlike her own, kept in abeyance for the
time her eagerness for a binding theory which could bring her
own life and doctrine into strict connection with that amazing
past, and give the remotest sources of knowledge some bear-
ing on her actions. (10: 112)
The passage presents theories as things denied to young

women, even the best educated of them, because of the weak-
ness of female education. And, therefore, the narrator sees
as entirely understandable Dorothea’s assumption that her

marriage and secretarial work for her husband will open the
world of theories to her.
Of course, the narrative quickly shows the reader the mistake
in Dorothea’s assessment of Casaubon’s intellect; but the novel
doesn’t identify the central problem for Dorathea as being with
Causabon’s (or her) aspiration toward an overarching theory,
but rather it’s with Casaubon’s inability to move from gath-
ering facts to assembling theories. And Dorothea’s brighter
mind realizes his intellect’s failings as she ponders Casaubon’s
dreadful request that she complete his work after his death:
“And now she pictured to herself the days, and months, and
years which she must spend in sorting what might be called
shattered mummies, and fragments of a tradition which was
itself a mosaic wrought from crushed ruins—sorting them
as food for a theory which was already withered in the birth
like an elfin child” (48: 519). The linking of his intellectual
abilities with his failing potency through the image of still-
birth helps emphasize how Dorothea’s attempt to eroticize
intellectual life has failed her because she didn’t know enough
about the theory behind Casaubon’s self-presentation from
the beginning. But her theoretical ambition and sophisticated
understanding of his failings as a theoretician early on suggest
that her desire to participate in the forming of great theories
ranks higher on the scale of potential heroism in the novel
than her desire to build cottages for the poor. As if to confirm
that scale, Dorothea, expressing frustration after a morning of
trying to help her husband in his work, complains, “I find it is
not so easy to be learned as to plan cottages” (39: 423).
Thus far, the novel might have appeared to be leading toward
a vocation plot for Dorothea. Marriage having failed to pro-
vide her with the outlet for her “ardently willing soul” (pref-
ace 4), Dorothea might have imagined uses for the fortune
she inherits from Casaubon that would provide her with active
reform work. But once Dorothea’s confining marriage ends
with Casaubon’s death, she continues to invest herself and her
money in supporting the grand schemes of others, rather than
becoming an active reformer herself. Her next heroic act in the
novel is to stand by Dr. Tertius Lydgate when his reputation is

tarnished and the fate of his fever hospital threatened because
of his association with the crooked banker (and financial backer
of the fever hospital), Nicholas Bulstrode. In offering financial
support and fellowship to Lydgate, Dorothea also provides
an endorsement of Lydgate’s beliefs in modernizing medicine
with the theories, techniques, and instruments he has learned
in his medical training in the leading medical schools in Paris,
Edinburgh, and London. As she tells Lydgate at the moment
when she offers him money to salvage his name and his fever
hospital from the scandals associated with Bulstrode:
Suppose we kept on the Hospital according to the present

plan, and you stayed here though only with the friendship and
support of a few, the evil feeling towards you would gradu-
ally die out; there would come opportunities in which people
would be forced to acknowledge that they had been unjust to
you, because they would see that your purposes were pure.
You may still win a great fame like the Louis and Laennec I
have heard you speak of, and we shall all be proud of you,” she
ended, with a smile. (76: 821–22)
Eliot allows her reader to imagine that Lydgate has shared

with Dorothea his excitement about the medical research he
became familiar with in his medical school studies and, indeed,
shared with her his own ambition to become a great discoverer
in medicine. Laennec, of course, invented the stethoscope,
which Lydgate uses on patients to the disgust of his fellow
Middlemarch medical practitioners who consider it represen-
tative of “the noise and show that is the very essence of the
charlatan” (45: 494).
But, the historical figure who appears more prominently
in the novel in association with Lydgate is Pierre Louis, with
whom the novel tells us that Lydgate studied in the late 1820s
when the Paris physician was becoming famous in medical cir-
cles for several reasons, perhaps most prominently for suggest-
ing that typhoid and typhus were, in fact, two different kinds
of fevers—the current understanding being that all fevers were
of a single type. The single-fever theory that Louis’s work

challenged was crucial to mid-century sanitarians, a point to
which I will return below. Eliot interrupts the marriage plot
between Lydgate and Rosamond Vincy in order to develop
her readers’ perception of the innovative nature of the dis-
ease theories Lydgate pursues in his microscopical researches,
along with his search for the “primary tissue” from which, he
believes, all life is built:
But since he did not mean to marry for the next five years—
his more pressing business was to look into Louis’ new book
on Fever, which he was specially interested in, because he had
known Louis in Paris, and had followed many anatomical
demonstrations in order to ascertain the specific differences of
typhus and typhoid. (16: 170)
Lydgate’s association with Louis’s medical theories and prac-

tices would be even more striking to those informed about
developments in pathological anatomy and disease theory at
the Paris medical school where Lydgate studied.
Observing Fever: Facts, Theories,

Medicine, and Reform
Louis was famous in Paris for his microscopical researches,
for revolutionizing the method of taking patients’ histories by
asking questions that would not lead the patient toward par-
ticular answers, and finally, for keeping careful records of each
of his patients’ appearance, pulse, and temperature in a fashion
that resembles the keeping of vital statistics today, where stan-
dardized measures of health are taken often in advance even of
a physician’s entering the examination room. As one medical
historian puts it, Louis was “the first to make statistics the
basis of medicine” (Ackernecht, Paris Hospital, 10).
While it may seem surprising now that information pro-
vided by technologies as old as the thermometer, the stetho-
scope, and the microscope would be challenged, the medical
profession had not yet accepted these instruments in part
because of their invasive nature. Lydgate’s use of a stethoscope

and a thermometer on his patients, let alone his touching
the patient to take a pulse, would have been seen by many as
an unseemly penetration of the body, particularly when that
body was female. And strict empiricists, including Lydgate’s
hero in pathological anatomy, Xavier Bichat (whose works
inspire Lydgate’s own “moment of vocation”) still challenged
the efficacy of microscopic observations because one had to
believe that all of the theories of optics were flawless in order
to assume that what one saw through the microscope was
exactly what one would see were the object of a comparable
size to the observer.
For an empiricist sanitarian such as Nightingale research
in such areas as microscopy and auscultation would appear
to sidetrack the medical profession away from what she saw
as the moral obligation medicine should feel to respond to
the overwhelming evidence, apparent to the unaided senses,
that environmental factors caused disease and enabled its
transmission. Developments at the Paris school would come
to have profound effects on the British sanitary movement in
later decades. In concentrating on fever through microscopi-
cal and comparative researches of the type Lydgate practices,
Eliot seems uninterested in making Lydgate prescient as far as
the sanitary movement that develops in England shortly after
the setting of Middlemarch, though Lydgate is way ahead of
his time as far as British medicine went in the late 1820s and
1830s in his knowledge of Paris research and his incorpo-
ration of that research into his own research and practice.14
Nightingale will have recognized that the path Lydgate is on
in his research and in the kinds of research the novel implicitly
endorses is research based in principles that contradicted her
own commitment to sanitary science.
Eliot even goes so far as apparently to mock the use of statis-
tics in medicine when her narrator describes the Middlemarch
community’s initial reactions to Lydgate when he first arrives
in the community. In a passage describing the Middlemarchers’
confused reactions to Lydgate, Eliot makes reference to bad
statistics and links them immediately to new, insufficiently
tested ways of measuring health, and sensational ideas about

the transmission of disease:
Lydgate had not long been in town before there were par-
ticulars enough reported of him to breed much more specific
expectations and to intensify differences into partisanship;
some of the particulars being of that impressive order of which
the significance is entirely hidden, like a statistical amount
without a standard of comparison, but with a note of exclama-
tion at the end. The cubic feet of oxygen yearly swallowed by
a grown-up man—what a shudder they might have created in
some Middlemarch circles! ‘Oxygen! nobody knows what that
might be—is it any wonder that cholera has got to Dantzic?
and yet there are people who say that quarantine is no good!
(35: 306)
The passage is difficult because it makes what seem to be

huge conceptual leaps from talk of “particulars,” to “statisti-
cal amount[s],” to cholera, contagion, and finally quarantine,
without explaining the sources of the references. Though sel-
dom commented on by the novel’s critics, this passage pro-
vides a glimpse of the medical contexts about which and
within which George Eliot was writing. It suggests the diffi-
culty the Middlemarchers feel in assessing the qualities of this
unknown doctor—his uniqueness makes his abilities and his
worth un-measurable by their usual standards. But the passage
also alludes to the real difficulties the medical profession was
facing in incorporating what we now would call “vital statis-
tics” into its practice.
The phrase, “statistical amount without a standard of com-
parison,” when connected with the idea of measuring “the
cubic feet of oxygen yearly swallowed by a grown up man”
probably alludes specifically to medical researchers’ efforts
to produce a standard by which to study respiration. In his
1846 monograph, “On the Capacity of the Lungs, and on the
Respiratory Functions, with a view of establishing a Precise
and Easy Method of Detecting Disease by the Spirometer,”
Dr. John Hutchinson describes his invention, the spirometer,
the first instrument devised to standardize the medical obser-

vation of breathing. Medical historian, Stanley Joel Reiser
argues that part of the purpose of Hutchinson’s invention
was to change medical observation from a process where an
individual doctor observed symptoms and then subjectively
diagnosed them, to a process where those symptoms could
be measured quantitatively and graphed so that many doctors
could have a numerical medical record that was (ostensibly)
objective and verifiable.15 Hutchinson claimed he had been
able to determine a “healthy standard” inductively after recog-
nizing that there was a relation “intimately existing between
[lung] capacity and power, and the height of the individual”
(Hutchinson 197).
Though some were skeptical of the claims Hutchinson
made for his invention from the beginning, criticism of the
spirometer, the “vital capacity index,” and “healthy standard,”
came primarily when it was discovered shortly afterward that
Hutchinson’s spirometer would indicate a deficiency in vital
capacity in people who were believed to be otherwise perfectly
healthy. This initial failure convinced many that physiological
activities were too complex to represent numerically and that a
statistically produced normal standard could not be relied on
to determine normal from pathological states (Reiser 94).
To put her medical doctor at the cutting edge of research in
the late 1820s and early 1830s, Eliot would have had to show
Lydgate as having an interest in the research considered most
ground breaking while also managing to minimize the associ-
ations between him and those trends that would fall into dis-
repute toward mid-century, such as Hutchinson’s spirometer
and some of Pierre Louis’s early attempts to standardize stud-
ies of health.16 Sanitary statistics, such as those Nightingale
championed, and indeed sanitary principles in general, receive
no considered attention or credit for breakthroughs in the
diagnosis and treatment of disease either from Lydgate or the
narrator in Eliot’s text.
Eliot’s decision to show Lydgate as interested in “compar-
ative investigations” derived from the observation of people
(as opposed to sanitary statistical studies focused primarily
on environments) and microscopical researches may also have

been an effort to protect her hero from the mid-century med-
ical community’s objections to what they saw as the overvalu-
ing of statistical studies of health in wake of public health
movements of the 1840s that they associated with the studies
of non-medical social reformers such as Nightingale, Edwin
Chadwick, and James Phillips Kay. In one editorial from the
June 11, 1859 issue of The Lancet, statistics are branded as the
work of dilettantes from outside of the medical community
whose ignorance of medical research threatened to distort sta-
tistical findings:
We live in increasing danger of being overridden by statisti-

cians, who, sitting in snug cabinets, marshal huge columns of
figures, put them through elaborate evolutions, and gain, to
their own satisfaction, imposing victories over common sense,
fact, and direct observation. These gentlemen rarely suspect
that their numerical facts may be but a congeries of falsehoods,
of imperfect observations, of preconceived notions, and errors
of infinite sources which it is impossible to trace back. Hence
it is, we presume, that your thorough-bred statistician never
indulges in analysis.17
In the hands of government bureaucrats statistics could be

manipulated by chance or, as the references to the “snug cabi-
nets” and to the bureaucrats acting to “their own satisfaction”
suggest, in the interests of personal or political ends, rather
than scientific ones.
Even eight years after the serial publication of Middlemarch
began, microscopist and medical researcher, Lionel Beale,
complained that interest in medical statistics had hindered the
progress of microscopy in medicine:
Much labor and money have been spent in obtaining statistical

information concerning many diseases. Careful observations of
a general kind have been prosecuted, and doubtless thoroughly
well prosecuted, and accurately recorded in Government, and
an enormous amount of information has been recorded in blue
books. But why can we not have, in addition to this, the results
of very minute and careful investigations by physicians who
have made themselves skilled physicians, chemists, and micros-
copists? (Beale, 3)
From Beale’s introduction, particularly in his mention of the

bureaucratic emblem of the government blue books, we can
see that one of the reasons statistics and microscopical research
are in competition for attention is that the former already had
the support of liberal social reformers in government and from
outside of the medical community, who were interested in san-
itation and hygiene, such as Nightingale and Chadwick.
Beale’s concern, however, was not just that social reform-
ers have swayed the tide of medicine away from research but
that, in the process, liberals have produced a suspicion of sci-
entific research as having dehumanized the once-kindly doc-
tor. Beale writes, “not a few benevolent persons will perhaps
think that the scientific investigation of disease means, in
plain English, performing scientific and necessarily unjusti-
fiable experiments on the sick poor” (Beale, 9). Middlemarch
reflects sympathy with Beale’s concerns in its representation
of the panic produced in Middlemarchers when Lydgate asks
for permission to autopsy the body of a respectable and poor
member of the Middlemarch community, Mrs. Goby. Perhaps
the novel’s resistance to the term statistics, except in narrative
intrusions such as that mentioned earlier which referred to
Lydgate as a “statistical amount without a standard of com-
parison,” reflects a concerted effort on George Eliot’s part
to distance her doctor from too close association with those
whose well-intentioned efforts, according to Beale, may have
slowed down the progress of medical research in the years to
come.18
Ironically, the only other reference to statistics in the novel
comes in a description of Lydgate’s own thoughts about his
probable success in changing Middlemarchers’ attitudes
about his new methods of medical diagnosis and therapeutics:
“Considering that statistics had not yet embraced a calcula-
tion as to the number of ignorant or canting doctors which
absolutely must exist in the teeth of all changes, it seemed to

Lydgate that a change in the units was the most direct mode
of changing the numbers” (15: 151). The attitude toward sta-
tistics here suggests the narrator’s sense of the rather frivolous
uses to which statistics could be used. At the same time, the
passage manages to describe effectively the difficulty Lydgate
expects in winning the confidence of prospective patients
when he first arrives in Middlemarch.
This portrait of the benevolent and misunderstood Lydgate,
whose research has put him on the cutting edge of devel-
opments about anatomy and disease theory to come in the
1870s and 1880s,19 worked against much of the perception
of medicine that Nightingale hoped to create in her writing.
Nightingale’s commentaries about contagion suggested that
those pursuing theories of contagion were pursuing personal
heroism rather than prioritizing the practical work of sav-
ing lives by using sanitary data to prevent the environmental
causes of disease. Her anti-contagionist convictions were sup-
ported by her faith: she believed that God provides humanity
with empirical evidence of the environmental causes of dis-
ease; humanity just refuses to follow the trail of evidence God
has provided, preferring foolishly and egoistically instead to
follow theories of disease transmission.
Eliot alludes to theories of contagion in the same rather hys-
terical passage referring to the Middlemarch public’s reaction
to Lydgate as a statistic without any comparative standard,
quoted above. The association between inadequate statis-
tics and theories of disease was just the kind of association
Nightingale most despaired of. The passage from Middlemarch,
after describing Lydgate as “a statistical amount without a
standard of comparison,” continues by questioning the value
of measuring of “[t]he cubic feet of oxygen yearly swallowed
by a grown-up man,” before leaping into a statement about
the spread of cholera and the necessity of quarantine regula-
tions: “ ‘Oxygen! nobody knows what that might be—is it any
wonder that cholera has got to Dantzic? and yet there are peo-
ple who say that quarantine is no good!” I assume that George
Eliot’s narrator is adopting the voice of Middlemarchers for
the sake of humor. She either presents them as medically and

scientifically uninformed or, perhaps more edgily, she presents
them as adopting the current popular beliefs about disease
transmission. The anxiety reflected by Middlemarchers over
the possible lifting of quarantine regulations might appear to
suggest George Eliot’s own anti-contagionist stance, given the
seemingly ironic tone of the narrator. Quarantine only works
if disease is thought to occur between bodies, possibly by
means of a single contact with an infected person’s body prod-
ucts, which could be stored in sheets, pillows, etc. Quarantine
would be nearly pointless if disease were generally thought
to be entirely a matter of environmental pollutants and not
caused by contagions that were as yet invisible to the medical
doctor.
One can imagine Nightingale being pleased with the por-
trait this passage suggests of supporters of quarantine being
hysterical, foolish, and uninformed. But Eliot’s passage isn’t
clearly being sarcastic here. The late 1860s, when George
Eliot was writing Middlemarch, was the precise period when
germ theories of disease were beginning to receive more atten-
tion among medical professionals because of microscopical
researches such as Lydgate’s. While Lydgate does not comment
directly on the disease theory question, he does recognize that
Fred Vincy is suffering from typhoid and not typhus, diseases
that medical researchers did not distinguish from one another
until Louis’s famous 1828 tract, and even after Louis’s discov-
eries English hospitals did not distinguish between the two
diseases until the 1860s.20 Medicine of the 1820s in England
was still invested in the single-fever theory of disease, which
contradicted the notion there was one type of germ for each
type of disease. The single-fever theory thus was crucial to
Nightingale and the anticontagionist proponents throughout
the early and mid-nineteenth century.
Middlemarch also indirectly challenged the single fever
theory of disease and the positivist medicine that led to it
in its other references to medical research and practice of
the Paris school where Lydgate studies. The novel refers to
Francois Broussais as one of Lydgate’s teachers in Paris as well.
Broussais is a crucial figure in the development of positivist

medical research as we shall see.21 But Lydgate’s own research
and practice diverges significantly from Broussais’s. Among
other things, Broussais was famous for his aggressive thera-
peutic technique of copious bloodletting, a technique the
novel comments on in the following passage:
For the heroic times of copious bleeding and blistering had

not yet departed, still less the times of thorough-going theory,
when disease in general was called by some bad name, and
treated accordingly without shilly-shally—as if, for example, it
were to be called insurrection, which must not be fired on with
blank-cartridge, but have its blood drawn at once. (15: 97)
The tone of the passage toward its subject, “heroic medicine,”

is obviously critical. While the “heroic times” being described
here might resemble the medicine of the eighteenth century,
there is also likely a reference to debates about therapeutics of
the early part of the nineteenth century. Louis’s 1828 essay
on the ineffectiveness of bleeding as a therapeutic technique
in treating disease helped to dethrone Broussais as the lead-
ing medical figure at the famous Paris school of medicine, a
position Broussais had held since around 1816. During his
figurative reign in Paris, Broussais also had an enormous
influence on American and British medical students alike
as a champion of “heroic” medicine, a practice that rejected
the popularly held Hippocratic theory of the curative pow-
ers of “nature” and the patient’s own “natural” setting.22 Vis
medicatrix naturae, as this particular Hippocratic theory was
called, is exemplified in the “expectant method” that Lydgate
practices with Mr. Trumbull. Broussais’s prescriptions for
excessive bleeding, by contrast, called for an aggressive attack
on disease at its specific location in the body. If George Eliot
is thinking of Broussais in the passage above, then it looks
as if she is suggesting that Broussais himself was falling into
“metaphysics” in calling disease “by some bad name,” and
aggressively treating it as “insurrection,” an observation I will
return to shortly.
Broussais’s diagnostics and therapeutics were based on a par-

ticular single-fever theory of disease that he developed. Rather
than considering disease to be an independent element existing
within and attacking the body, Broussais argued that disease
was actually a change in function, an inflammation, most often
(in Broussais’s own work) of the gastrointestinal tract. Many,
including such eminent medical figures as Charcot, credited
Broussais with shifting the popular emphasis in disease theory
from the old concentration on symptoms and essential fevers, as
illustrated in Phillipe Pinel’s Nosographie Philosophique (1798),
to a new focus on what was to become known as “physiolog-
ical medicine” (Ackernecht, Paris Hospital, 61–82). According
to Broussais, Pinel’s nosology was simply “arbitrary” ontology.
Broussais’s critique of Pinel’s nosology sounds, of course, posi-
tivist. In the conclusion to his history of medical perception of
the eighteenth century, The Birth of the Clinic, Michel Foucault
describes the new era of physiological medicine and its anatamo-
clinical method as having been ushered in by Broussais and
transformed into “the historical condition of a medicine that is
given and accepted as positive” (Foucault 197).23
According to Auguste Comte, too, Broussais was “the
founder of positive pathology” (Comte 648). Comte describes
how Broussais’s theories built on the work of Bichat, whose
discoveries are the catalyst for Lydgate’s “moment of voca-
tion” (Middlemarch 15: 98). In an 1828 essay entitled
“Examination of Broussais’s Treatise on Irritation,” Comte
describes Broussais’s indebtedness to Bichat:
M. Broussais, starting from the general anatomy founded by

Bichat, placed pathology on its true basis, presenting it as the
investigation of deteriorations to which tissues are liable and
of the phenomena thence resulting. He first clearly recognized
diseases are only symptoms, and that functional derangements
cannot subsist without the lesion of organs or rather of tissues.
(Comte, 648)
Clearly Broussais’s influence during the period about which

George Eliot is writing—particularly his antiontology,
antinosology, and localism—and his decline in popularity fol-

lowing Louis’s (and others’) more successful explanations of
disease, are pertinent to the presentation of Lydgate’s approach
to disease in Middlemarch. Broussais’s rejection of ontology as
simply “romans” in which the “symptomatologist mistakenly
mistook the event for the cause” was enormously important
for his time (Ackernecht, Paris Hospital, 68). In its rejection
of causative explanation it was for obvious reasons attractive to
Comte and his admirers.
George Eliot’s implicit critique of Broussais, however, if I
am correct in reading the passage about aggressive therapeu-
tics from Middlemarch quoted above as such, would suggest
that her attitude contrasts with Comte’s, for Comte treats the
single fever as precisely non-metaphysical, i.e., “positive,” just
a matter of symptoms. And in this George Eliot may be seeing
deeper. The single interior fever, even if thought of as a neu-
rophysiological entity, may be no more scientifically positive a
notion than the notions of “contagions.”
Broussais’s 1832 monograph on the recent outbreak of chol-
era from the position of “physiological medicine” revealed to
his critics the inability of his theory to explain or to treat chol-
era successfully and thus precipitated his decline as a promi-
nent theorist in Paris (Ackernecht, Paris Hospital, 66–67). The
failure of his anti-contagionist theory reopened discussion of
the possibility that while some forms of epidemic disease, such
as yellow fever, might popularly be held not to be contagious,
typhoid, cholera, and others probably were contagious (to a
greater or lesser extent in each case).
In one set of her extensive writing notes for Middlemarch,
known as the “Quarry,” in which she kept track of histori-
cal developments in medicine, religion, politics, etc. from the
1820s and 1830s, Eliot wrote that the Broussaisian single
disease theory was the very stumbling block that prevented
English doctors from recognizing the distinction between
typhoid and typhus:
The question excited considerable interest in France, but less

in England where a strong bias has always prevailed towards
a belief in the doctrine of a Single Fever. But dissenters arose.

Scotch, English, and American physicians, familiar with the
fevers of their own countries, began to visit Paris to study fever
there; & they were not long in learning the chief points of dif-
ference between the two fevers. (“Quarry,” 616)
Clearly George Eliot saw the single fever theory as already

having been shot down in Paris by the time that Lydgate is
supposed to have been studying there. Later in her notebooks
she describes Louis’s work on typhus and typhoid, by contrast,
as “the first to give a complete and connected view of symp-
toms as well as of post-mortem lesions in the fever common in
Paris” (“Quarry,” 616).
I stress the importance of Louis and the references to the
decline of Broussais in the journals and the novel because
the implied history of medical developments in Middlemarch
challenges the logic of most of the principles and assumptions,
both scientific and moral, that sanitarians such as Nightingale
held dear. The development of Lydgate’s heroism in the novel
may well have bothered Nightingale as much for the ways
that his sophistication as a researcher never trumps the sym-
pathetic nature of his interactions with patients. Like Eliot,
Nightingale was concerned with larger issues of the effects
of scientific research and sympathy on clinical medicine.
Nightingale urged a positivist approach to nursing—women
should learn the facts about disease as they were evident to
the unaided senses. And she firmly believed that doctors
did more harm than good by pursuing their self-interested
research based on theoretical assumptions about the nature
of disease and by practicing heroic therapeutics at the expense
of recognizing the evidence of sanitary causes provided by a
benevolent God as well as the curative powers of the body
itself. In an 1869 letter to a friend, Nightingale wrote of doc-
tors, “With two or three brilliant exceptions, ‘the doctors’
are far behind a humble, experienced nurse in such matters
as how disease is produced, ‘contagion’ and the like. Poison
a nurse with medical “contagious” theories and she will be
ruined. For yourself alone” (CW 8: 53).
Medical Science and Sympathy

Unlike other doctors in Middlemarch, Lydgate doesn’t prac-
tice “heroic” medicine and his beliefs about the curative
powers of the body and their relationship to health and dis-
ease are far closer to Nightingale’s own than she would have
cared to recognize. Certainly his practice of “the expectant
method,” in which the physician withholds aggressive ther-
apeutics in the interest of watching to see if the body heals
itself, would have met with her approval. But positive med-
icine takes Lydgate further in the direction of germ theory
than she would have expected. And in 1871 Nightingale wor-
ried desperately that such theories would seriously damage
the sanitary progress she had worked so hard to accomplish in
public health policy.
Moreover, Lydgate’s scientific pursuits show no signs of
interfering with his ability to sympathize with patients. His
obsession with microscopical researches and “comparative
investigations” of vital statistics in his fever hospital nega-
tively affect his ability to recognize the signs of disaster in
his marriage to Rosamond, since, as the narrator explains, he
does not bring the same “testing vision of details and rela-
tions,” to his consideration of marriage that he does to his
medical researches (193). But his research seems, if anything,
to improve his abilities as a clinician able to use sympathy to
determine appropriate diagnoses and therapeutics.
Lydgate’s concentration on his patients as individuals
evinces his ethical commitment to his patients even though
Britain had no universal, established codes of medical ethics;
it also indicates Lydgate’s and Eliot’s assumption that sym-
pathy brings about improved clinical perceptions of the person
who is the object of the medical practitioner’s sympathy. Eliot
makes clear that the priority Lydgate places on his concern
with the sympathetic observation and care of patients differ-
entiates him from the old guard of Middlemarch physicians,
who appear to value traditional ideas of medical etiquette
between physicians—which protect the interests of doctors
rather than patients—over any ethical or sympathetic claims
patients may have felt they had over their physicians to pro-
vide optimal care. When Lydgate begins to treat other physi-
cians’ patients whose illnesses have been misdiagnosed, and
when he publicly discredits other physicians’ dispensing of
drugs, the other Middlemarch practitioners view his actions
as a breach of medical etiquette. In the eyes of the narra-
tor, however, it seems that Lydgate’s decisions in these cases
would accord with the relatively new concept of medical
ethics—a philosophical concept based in eighteenth-century
ideas about sympathy.
Britain’s earliest work on medical ethics, John Gregory’s
Lectures upon the Duties and Qualifications of a Physician
(1772), stressed the need for physician to “feel the distresses”
of patients. Such feeling would “incit[e]” physicians to relieve
their patients’ suffering. Gregory’s stress on the physician’s
need to feel patients’ suffering shows the influence of David
Hume’s concept of sympathy, which explains moral senti-
ments according to a psychological notion of sympathy.24 In
the novel Lydgate has passed some of his medical studies in
Edinburgh, where Hume and Gregory, a professor of Physic,
worked together, though years earlier than Lydgate’s educa-
tion there.
We see that the novel places a high value on Lydgate’s sym-
pathy when, for instance, after spending much time by the
bedside of Dorothea “while her brain was excited” during the
period after her husband’s death, Lydgate recommends that
Dorothea’s initially over-protective sister, Celia, and brother-
in-law, James Chettham, allow Dorothea to “do as she likes,”
claiming that Dorothea “wants perfect freedom more than
any other prescription” (341). Here, Lydgate’s diagnosis would
appear to be based as much on his sympathy for her position,
as anything else. Elizabeth Ermarth argues that the concept of
sympathy underlies Eliot’s depiction of social and moral prob-
lems in her middle and late novels—the later novels extending
their focus beyond depicting sympathy between people who
know each other well, to detailing sympathy between peo-
ple more casually related.25 The physician-patient relationship
provides a perfect example of such a casual, but vital, relation
in which society’s faith in some kind of mutual sympathy is

required in order for society as a whole to be cared for. The
danger to society of the absence of such sympathy in a medi-
cal figure seems to be evident when Bulstrode takes over the
care of Raffles and allows his patient to die by not following
Lydgate’s prescriptions. Individual acts prompted by sympathy
appear to keep the social fabric of Middlemarch together. And
indeed, such sympathy may be the only basis for true heroism
in the novel.
Middlemarch ultimately provides in its plots that concern
Dorothea and Lydgate an immensely complex portrait of two
heroic figures who accomplish comparatively little to improve
the world by Nightingale’s standards—Lydgate eventually
achieves a modicum of fame for a treatise he writes on gout
(which medical research of the time assumed was a disease
of the aristocracy) and Dorothea becomes Will’s helpmeet in
politics, wife, and eventually mother to their child. But Eliot
makes her case compellingly that “the growing good of the
world is partly dependent on unhistoric acts; and that things
are not so ill with you and me as they might have been, is half
owing to the number who lived faithfully a hidden life, and
rest in unvisited tombs” (896). Nightingale probably agreed
in some measure with the sentiments expressed in this last
passage in Middlemarch, particularly given her own decision
to work largely behind the scenes after her return from the
Crimea.
But in its creating heroes of Dorothea and Lydgate
Middlemarch stepped on Nightingale’s toes in many more ways
than those she admitted to her friend Jowett. Surprisingly,
however, the fact that Middlemarch all but completely erases
the sanitary ideal from medical history—and through that
erasure omits any reference to the vocational opportunities it
opened for women through Nightingale’s own hard work—
never enters into Nightingale’s written critique, either in
her published essay or her correspondence with Jowett. One
wonders if she even recognized herself how deeply the por-
traits of heroism in sympathetic self-denial that Eliot provided
contradicted so many of her prized views about the failings of

scientific medicine, the virtues of sanitary science, and the role
that sympathy might play in the development of both. Instead,
she concentrated her public critique on the representation of
Dorothea’s failures of imagination—perhaps so she wouldn’t
have to recognize all the ways the imagination of Dorothea’s
creator challenged her own views.
Chapter 4
E ng agi ng t h e Vic t or i a n R e a di ng
P u bl ic: Nigh t i ng a l e a n d t h e
M a dr a s Fa m i n e of 1876
If English people knew what an Indian famine is—worse

than a battlefield, worse even than a retreat, and this fam-
ine too, in its second year—there is not an English man,
woman, or child who would not give out their abundance
or out of their economy.
—F. Nightingale, Published Letter to
the Lord Mayor, 18771
We do not care for the people of India. This is a heavy

indictment: but how else to account for the facts about to
be given?
—F. Nightingale, “The People of India,” 18782
Florence Nightingale declared with confidence in 1877

that English people would generously give to alleviate the
suffering of Indian people during the famine then current in
Madras—if only they knew how bad that famine was. Only
one year later she changed her tune. Published in the liberal
journal, The Nineteenth Century, Nightingale’s 1878 article,
“The People of India,” contains her boldest statement of dis-
appointment about government and public inaction in the face
of the mass numbers of dead and starving in the famine in
Madras. Nightingale began the essay with a startling accusa-

tion: “We do not care for the people of India.” Here, for the
first time, she implicated the British public in her condemna-
tion of the government’s economic and social policies toward
India, which she now recognized had exacerbated and, in some
cases, even produced the conditions that made India vulner-
able to famine. For a reformer whose reputation had been built
on the image of her as a ministering angel to the troops in the
Crimea (however much she may have wished that image were
other) to accuse her country of not caring about its colonial
subjects was a bold and perhaps even desperate move.
The task of raising British sympathies toward Indian natives
in 1878 was daunting: the British public, even when not
overtly hostile to the Indian peasant population, were none-
theless fearful. One might think, as Nightingale initially did,
that the sheer number of deaths already in Madras (“5 or 6
millions”), ought to have shocked the British public into an
examination of its government’s policies in India (CW 9: 757).
But Nightingale soon perceived that the obstacles to raising
British sympathies toward suffering Indian peasants were
greater than she had thought. She had first to acknowledge and
neutralize British anxieties about the sheer numbers of native
Indians,3 their religious beliefs (of the varieties of which she
knew many British were entirely ignorant), and their history of
revolt against their British rulers. The Sepoy Mutiny of 1857, in
which native Indian soldiers serving in the British army, as well
as civilian natives, violently revolted against the British, took
much of Britain by surprise. Though she appears not to have
commented on it in her correspondence, Nightingale would
almost certainly have been well aware of the treatment William
Howard Russell received in the Anglo-Indian press after he
attempted to provide even-handed reporting from India in let-
ters he published in The Times shortly after the 1857 mutiny.
According to his biographer, J. B. Atkins, Russell
had become the object of violent disparagement and abuse in

the Indian press The papers were quite intolerant of anybody
who, for the sake of the feelings of those who had lost friends
Engaging the Victor i a n R e a ding Public 111
or relations, tried to mitigate the horrors which had occurred

in the outbreak, or endeavoured to arrest any measures savour-
ing of revenge. (Atkins, Life of Sir William Howard Russell,
1. 295)
Russell’s reporting from the Crimea had at least in part inspired

the effort which led to Nightingale’s own work in the Crimea
and, perhaps more importantly, it “launched a new era of war
reportage, and of the mobilization of middle-class opinion to
generate reform” (Bostridge, 203). Of course such reporting
was a tool Nightingale herself employed, as we’ve seen.
Since the mutiny, the British had followed anxiously several
peasant revolts: the Indigo Revolt in Bengal against exploi-
tation by the European planters, 1859–1862, the Pabna dis-
turbance against land-holders in 1873, and the Deccan revolt
of 1874 against native moneylenders. Though the particular
circumstances of each of these uprisings differed, they each
involved the efforts of the native peasantry, called Ryots [in
the Madras region], to fight back against exploitive British
economic and legal policies that supported the practices of
the exploitive landholders and the money lenders. In almost
every region of the country the peasant population faced des-
perate conditions of poverty, hunger, and disease. The terms
of the Permanent Settlement of 1793 involving agriculture,
trade, land tenancy, and money lending had provided a few
provisions intended to protect the Ryots’ interests; but the co-
lonial government did little to enforce those provisions. The
Ryots were left vulnerable to government and government-
appointed native rent collectors (known as Zemindars) who
had the ability to set rents as high as they liked, as well as to
crooked British and native money lenders.
This chapter addresses Nightingale’s rhetorical and narra-
tive strategies in her public writings on famine in India. These
strategies reflect her perception that too few British govern-
ment officials and citizens shared her sense of the urgent need
to change their government’s policies. Reflected too in the
differences between the 1877 letter—with its confidence in
her fellow English people’s capacity for compassion toward
Indian natives—and the 1878 essay chiding them for their

lack of concern is the fact that over time, and with her inc-
reased familiarity with Indian social and economic conditions,
Nightingale’s perceptions of the value of English governance
in India had altered considerably. As Jharna Gourlay has
argued, Nightingale now saw Britain as bearing a large share
of accountability for the famines that ravaged India through-
out the period of British rule.
When Nightingale first turned her attention to India in
the interests of studying sanitary problems in the army she
was still directing nursing in Scutari during the Crimean War.
Nightingale had then “wanted to solve the problems of India
with the knowledge, concepts, and skills that had worked in
Britain” (Gourlay, 14). As we’ve seen in earlier chapters, the
blossoming of the sanitary idea in the 1840s and 1850s had
produced numerous reforms in Britain; the same period saw as
well increasing numbers of implicit endorsements of the san-
itary principles on which those reforms were based appearing
in Condition of England fiction.4
After Nightingale recognized that combating sanitary prob-
lems alone would not bring about the changes she felt neces-
sary for the health of both the Indian army and the Indian
natives, Nightingale focused her writings of the 1870s on
issues of irrigation and exploitative land and money-lending
policies, all of which implicated the Indian colonial govern-
ment in producing famine conditions.5 During this process,
Nightingale began to recognize the difficulty she would have
in drawing English attention to Indian suffering. Instead of
working primarily with statistical data in her public writings,
she began to work with the goal of familiarizing her readers
with the lives of the Ryots, attempting to create for her readers
emotionally wrenching mental pictures of the Ryots’ industri-
ousness, benevolence, and victimization at the hands of both
native and colonial money lenders.
While I agree with Gourlay that by the 1870s Nightingale
had largely given up her initial idea of solving Indian prob-
lems by using strategies that had worked in Britain in the
1840s and 1850s, this chapter argues that in Nightingale’s
most rhetorically powerful essays on India of the 1870s she

appears nevertheless to have drawn inspiration from the nar-
rative strategies of the Condition of England novels of the
1840s and 1850s, which addressed the major social problems
of urban poverty and epidemic disease in rapidly industri-
alizing England. These were novels she read and admired
and with whose authors—Gaskell, Dickens, and Harriet
Martineau particularly—she corresponded. Unlike much of
the travel literature written by English visitors to India dur-
ing this period, the Condition of England novels Nightingale
admired reflect similar efforts to raise readers’ sympathies for
individual sufferers, while creating mental pictures of those
sufferers as typical examples of what she sees as the exception-
ally industrious Indian peasant. To provide such examples,
Nightingale began to solicit from Indian natives and govern-
ment officials illustrative narratives that focused on the lived
experiences of typical Indian peasants. She was then able to
draw on a vast pool of data in order to provide a mix of rhe-
torical and narrative approaches, as she addressed her various
audiences. This pool consisted, first, of factual data derived
from surveys she designed in the 1860s to study the sanitary
conditions of the army in India using the accounts of govern-
ment officials working in India; and second (and increasingly
in the 1870s) of the accounts of Indian natives of their lives
under the Raj.
In her most powerful public writings on the Indian famine,
she focuses on narratives of typical, unglamorous peasants’
lives, while finding within those narratives heroic attitudes
and behaviors; she adopts a tone of sympathetic advocacy that
asks readers to imagine the feelings of the Indian peasant in a
given situation; she provides her readers with what feels like a
casual accounting of the numbers of individuals in a given sit-
uation of poverty, work, or community effort, but then finds
within those numbers representative exceptional individuals
on whom to focus. All these narrative techniques, including
how the typical life may also show up as in some important way
exceptional, are used in the sentimental condition of England
novels of the 1840s and 1850s.
To describe the shifts in Nightingale’s rhetorical and nar-

rative strategies in her writings about India through the late
1870s, I begin first by tracing her developing understanding
of the causes of disease and famine in India in her public and
private writings from her earliest involvements in Indian issues
through the early 1880s. I then turn to a close reading of
“The People of India,” “A Water Arrival in India,” and other
published and unpublished writings of the late 1870s and early
1880s to illustrate how the focus and rhetoric of Nightingale’s
public writings changed. I describe how her work increas-
ingly draws strategic comparisons and contrasts between the
English and the Indian poor, and moves from the initial dis-
tinctly nationalist, colonialist rhetoric of her 1860s writings
to advocating home rule and native (in addition to English)
education for the Indian peasantry in the 1870s. As her per-
ceptions of the causes of famine change, so too do her strat-
egies for representing social problems in India to the British
public. And as she had done previously in her reformist efforts,
Nightingale appears to have turned to fiction as inspiration for
making her readers care about the issues as she did.
My goal here is not to make of Nightingale an ideal of
enlightened, progressive anti-imperialist thought; her nation-
alism and her faith in English moral superiority appear spo-
radically even in her late writings. But they do so primarily in
her public writings where such attitudes supported the rapid
achievement of her immediate goals in that particular writing.
She appears to have felt that achieving these goals was a far
more urgent goal than encouraging her reader to adopt a per-
haps more nuanced view. In other words, in any given reform
effort, Nightingale seems to have understood, appealing to
English virtues would be more likely to prompt citizens’ eco-
nomic or other support than either nuanced educating or even
scolding would. Nonetheless, her private writing makes clear
that she herself over time recognized and acknowledged con-
tradictions between the ideals of English governance that she
advocated (and believed were possible under the best English
leadership, such as that of her hero, John Lawrence, Viceroy
to India 1864–1869) and the reality of the lives that Indian
natives led under the poorer governance they were subjected to

in reality. Her advocacy of Indian home rule grew as she deep-
ened her understanding of the causes of famine and poverty in
India and as she increasingly made acquaintances and estab-
lished friendships with Indian natives. If the rhetorical power
of her late 1870s writings serve as an index of Nightingale’s
feelings on the subject of Indian famine and the suffering of
the Ryots under British rule, then it is clear that as her knowl-
edge base deepened on these subjects, so too did her urgency
about raising British sympathies for the Ryots and her willing-
ness to draw from the powerful narrative techniques of novel-
ists and essayists, such as Gaskell and Dickens, to succeed in
her efforts.
India, Army Sanitation, and

Nightingale’s Writings of the 1860s
To understand how her 1870s writings about the Madras
famine differ from her previous writings on India, I need
first to explain what the priorities and strategies of her ear-
lier writings on India were. Though her correspondence
indicates that her interest in India began while she was still
directing nursing in the Crimea in 1854, her first official
writing on India appeared nine years later. At the urging
of Edwin Chadwick, she had created surveys for the pur-
pose of studying sanitary conditions in the Indian army.6
The Royal Commission on India used the surveys to collect
reports on the sanitary conditions of its stations throughout
India. Hoping to reach a wider audience for their own report
on the Sanitary Conditions in the Indian Army of 1863,
the Commission requested that Nightingale write her own
report, Observations by Miss Nightingale on the Evidence
Contained in Stational Returns, to be appended to theirs
(CW 9: 131). Her report is typical of her own and other
prominent reformers’ 1860s writings in the ways it reflects a
vision of English moral superiority in which the conquering
nation “civilizes” their conquered subjects through the dis-
tribution of European technological and social advances.
In the Observations, for example, her representation of the

labor of Indian natives shows little explicit concern with the
humanity of the Indian workers. In one section describing
the inadequate irrigation in several sections of the country, she
refers to the native Indian workers, whose responsibility it was
to carry water in bags for their colonial employers (“Bheesties”),
as “human water pipes.” Her commentary appears to consider
them as commodities that are or are not being used in the best
economic interests of the colonial army.
Let the bheestie be for field service if no better device can be

discovered, but let some civilized method be adopted of sup-
plying barracks, garrisons, and towns with [water]. Besides,
human labor is daily becoming of higher value in India and
it may be actually more expensive to use men as beasts of
burden now than to use the appliances of civilization. These
water pipes with a will are not always found to answer[.]
(CW 9: 135)
Against the interpretation that she herself was entirely insensi-

tive to the humanity of the Beestie at this point in her career,
it could be argued that Nightingale was being practical in
making an economic argument for replacing the Bheesties’
hard labor with the “devices” of “civilization, rather than
attempting to convince the reader of the inhumane nature of
the work.7 This particular essay was, after all, likely to be read
primarily by influential government officials and those with
an economic interest in Indian affairs.
While there is little evidence in the Observations of the
championing of the heroic Indian peasantry that will feature
in her late 1870s writings, there is a subtle difference between
her tone toward the British army and the attitude toward
native behaviors of the Royal Commission, whose work
her essay supplemented. While the royal commission report
stressed that “the habits of the natives are such that, unless
they are closely watched, they cover the whole neighbouring
surface with filth” (CW 9: 131), Nightingale chose to lay the
responsibility for the poor sanitary conditions on the British
army. “Can it be possible,” she asked, “that such a state of

things exists after all these years of possession and unlimited
authority?” (CW 9: 174). Her reference to the “state of things”
avoids having to assign blame for its creation, but insists that
the moral stewardship of the British should have produced
some amelioration of the conditions simply by virtue of their
exertion on sanitary issues.
And Nightingale’s critique of British stewardship went even
further: she extended the blame for poor conditions in India
to the attitude of the British army toward the Indian natives:
Our men dislike and despise the natives and are regarded by
them in return more as wild beasts than fellow creatures. The
native, however, makes much more effort to learn the Briton’s
language than does the Briton to learn the native’s. It is diffi-
cult to give an idea of the evil effects of the gross ignorance of
all that relates to the country in the ranks of our army in India.
The commonest attempt at conversation gives rise to feelings
of impatience and irritation, too often followed by personal
ill-treatment. (CW 9: 167)
The last sentence suggests that, while Nightingale never got

to India herself, she was all too aware of the racism and bru-
tality sometimes latent in British army personnel in India. She
offers the suggestion that “every soldier should be required
to learn something of the native language” for which work a
“pecuniary reward” or “eligibility for employment in the var-
ious departments of the public service” should be offered as
enticements (CW 9: 167). Interestingly, here Nightingale does
not acknowledge the fact that there were multiple native Indian
languages the army might need to learn—a fact of which she
was well aware. The omission suggests that Nightingale may
have had no illusions that her suggestion would be taken up;
but laying responsibility on the British soldiers to improve
communications simply showed the army what measures it
could take, rather than simply (and lazily, in Nightingale’s
eyes) blaming the Indian natives for their sanitary problems
and uncomfortable relations with the natives.
Her attitude toward the native Indians in the Observations is

inconsistent—on the one hand she represents the Bheesties as
“human water pipes” available for the army to use for drudge
work if needed; on the other hand she insists that the army
should require its soldiers to take responsibility for its sanitary
problems and learn something of “the Indian language” to
improve their own quality of life in India. Nightingale is con-
sistent in her stance, however, in the Observations and in her
other 1860s writings on India, that the British should prove
their moral right to their tenure by setting an example of self-
help and by exhibiting the appropriate noblesse oblige behavior
toward their Colonial subjects.
In another 1863 published essay, “How People May Live
and Not Die in India,” which was read for her at the National
Association for the Promotion of Social Science in Edinburgh
that year, Nightingale explained her view of the moral respon-
sibilities that attended British stewardship of India over and
above the economic relationship from which the British had
already benefited:
The time has gone past when India was considered a mere
appanage of British commerce. In holding India, we must be
able to show the moral right of our tenure. Much is being
done, no doubt, to improve the country: by railways, canals,
and means of communication to improve the people: by edu-
cation, including under this work European literature and sci-
ence. (CW 9: 191)
Her words reflect classic cultural imperialism; they describe

how the improvements provided by the English raise the Indian
native’s quality of life, not only through scientific and techno-
logical advancement, but by making the Indian native think
more like a British subject. Her words suggest either naively
or strategically that the relationship between Britain and India
has been of one economic dependency in which India was
the “appanage” of its benevolent steward, Britain, ignoring
the exploitative nature of the actual economic relationship
that existed. The portrait she provides may be either strategic
or naïve because her later writings (and her personal writings

beginning around this time) begin to focus on the devastating
consequences on Indian peasants of these economic inequities.
Even in 1863, however, she insisted that the reforms she
and the Royal Commission advocated were designed not
just to improve the life of the soldier, but also the life of the
Indian subject. “But it is not for the soldier alone we speak.
The report has a much deeper meaning and intent than this:
it aims at nothing less than to bring the appliances of a higher
civilization to the natives of India” (CW 9: 190). Nightingale’s
personal writings confirm this attitude of cultural imperialism
as well: writing to John Lawrence on September 26, 1864, she
assures him, “Still, you are conquering India anew by civili-
zation, taking possession of the empire for the first time by
knowledge instead of by the sword” (CW 9: 212).
While her wish, stated earlier in the same letter, that hygiene
might be the “handmaid of civilization” has led historians to
dismiss the effects of her efforts in India as bringing cultural
imperialism under the guise of hygiene, there are signs, even
here, of Nightingale’s later focus on the Indian peasantry.
Earlier in the same letter Nightingale shows a rather different
priority, akin to the work she had been doing in Harley Street
working with prostitutes and the English working classes in
the urban squalor of London:
It seems to me so base to be writing while you are doing. Oh

that I could come out to Calcutta and organize at least the
hospital accommodation for the poor wretches in the streets.
There is nothing I should like so much. But it is nonsense to
wish for what is an impossibility. I am sure you will be glad to
hear that one of my lifelong wishes, viz., the nursing of work-
house infirmaries by proper nurses, is about to be fulfilled.
(CW 9: 212)
Nightingale’s reference to her Poor Law Workhouse reform

efforts, coming as it does, immediately after she laments the
impossibility of herself ever going to Calcutta to organize hos-
pital treatment for the urban poor, suggests that Nightingale
likened the work she did with the English poor to the aid she
wanted to see for the Indian poor. But she made little effort in
the 1860s to link the two populations in her public writings—
perhaps because she had not yet recognized parallels in the
dynamics of sanitation, economic disparities, and irrigation
inadequacies between the two populations; but perhaps she
also kept the parallels to herself for the strategic reason that
she saw little possibility that her readership would accept the
implicit comparison of English with Indian subjects.
Most English writings about India immediately following
the Sepoy Mutiny had, after all, provided the same kind of
Whig history about the increasing benefits to Indian natives of
English moral stewardship in India as that which Nightingale
presents in her 1860s writings. Nightingale’s close associate,
political and fiction writer, Harriet Martineau, wrote British
Rule in India (published in the same year as the Sepoy Mutiny,
1857), in her words to help enable the British reader “to bet-
ter understand the meaning and the bearing of the measures
which will be taken for the reaffirmation of our empire”
(Martineau, 355–56).
British Rule in India explains in decidedly positivist terms,
how the British should understand their struggle to establish
and maintain order in India.8 On the subject of reaffirming
the empire, Martineau writes,
It is naturally impossible for the superior race, in such cases, to

begin ruling with any adequate knowledge of the minds they
are dealing with. Above all, this mischief must exist when the
subordinate race has been surprised in that stage of civiliza-
tion in which the religious, political, and social institutions are
mutually incorporated. There is a period in the development
of every race and people where the priests, are, ex officio, rul-
ers, lawyers, legislators, physicians, and scholars; and it is then
impossible to touch any part of the polity under which they
live without affecting all the rest. (337)
Martineau casts the relationship between India and Britain into

the Comteian scheme. The Indian people, “the subordinate
race,” were, she claims, still in the theological, or perhaps at

best the metaphysical, stage of development in which religious
authorities still dictate the beliefs of the people, not having
yet developed a rational system of governing independent of
metaphysical authority. The British, “the superior race,” hav-
ing progressed further into the positivist state, inevitably must
struggle to reason against the Indian beliefs.
Martineau assures her reader, however, that the British
can counter what she sees as the superstition of the Indian
people by importing British “knowledge and capital” to
improve their material conditions. In what will prove a terri-
bly ironic move, she then draws her readers’ attention to the
spectacular British success in relieving and preventing fam-
ine in the Madras region. Of course nineteen years later in
1876 Madras would be enveloped again in horrific famine.
Without the benefit of foresight about the coming famine,
however, Martineau writes of British involvement in Madras
as evidence that the British have successfully defeated fam-
ine by countering Eastern superstition with Western science.
She writes, “Elsewhere [Madras] has been an opposite state of
mind growing up, under the irresistible influence of material
improvement. . . . British knowledge and capital [has saved the
region from famine by] deepening a stream here, embanking
another there; regulating and distributing the waters with sci-
entific foresight” (339–40).
Nightingale and Martineau were friends and shared
many goals with respect to public health reforms: in fact,
Nightingale’s statistics on the health of the army in the
Crimea had formed the basis for Martineau’s England and
Her Soldiers (1854) and Martineau had asked Nightingale
to help with sanitary efforts conducted in America during
their Civil War. Though Nightingale’s 1860s writings share
the view of the inevitable positivist development in the di-
rection of technology and empiricist observation, her views
of England’s benevolent role in “improving” India began to
change as she focused more closely on issues of irrigation and
land tenancy. Martineau’s essay provides an important docu-
ment to compare with the picture Nightingale paints of native
Indian and British relations in her early 1860s writings—and

to contrast with Nightingale’s later ones.
Shifting Strategy: Nightingale on

Irrigation and Water Supply
Sometime between 1863 and 1878 Nightingale’s goals in her
writings about India changed dramatically from advocating
for better wielding of British moral authority in government
to advocating that the British public urge its government to
fix its poor irrigation and land tenancy policies and ultimately
agitate for Indian home rule. Determining why she changed
her focus when she did can be difficult because specific exam-
ples of dramatic changes in tone or content in her rhetoric can
signal that she experienced a substantive change in her own
perception of the situation, but they can also simply mark a
change in how she wanted the situation to be perceived by
the public. She was, as her many biographers have remarked,
a master of manipulating perception. She got her friends,
Martineau and Chadwick, to review and publicize work that
she wanted to receive attention;9 she also worked hard behind
the scenes to manipulate politicians toward using the kind of
rhetoric she thought would be most effective in influencing
public opinion.
For example, irrigation and adequate water supply, which
she first addressed in describing the poor sewage in army
barracks and the inadequacy of the “water pipes with a
will” in her 1864 Observations, became by 1877 one of the
key focuses of Nightingale’s Indian writings. Irrigation, of
course, relates closely to sanitation: without water supplies
at the ready, sanitation is harder to manage. But an equally
important factor was irrigation for crops, for providing sus-
tenance to the millions of poor. Having seen the success of
irrigation works in four sections of Madras and the enor-
mous difference that those successes had made in the lives of
the Ryots, Nightingale, as usual, found and worked closely
with the experts in the field to assemble the information she
would need to analyze the situation thoroughly and create
recommendations, and then and only then, she made her

case to the British public.
Though she knew of a few successes, Nightingale’s self-
education on irrigation issues provided her with more exam-
ples of British failure in providing adequate irrigation to
regions within India. In her notes from an 1867 meeting with
Sir Bartle Frere, then Governor of Bombay, she describes the
situation of the cantonment in Pune, a town of 90,000 peo-
ple, and a neighboring town of 30,000 people, both of whose
drinking water was supplied by a river into which drainage
from the towns also flowed. When a native Indian philanthro-
pist offered to pay for the irrigation works that would provide
the towns with good drinking water, the first dam built by a
British Military engineer gave way, and then a second built
by a British civil engineer gave way. Finally, when native engi-
neers were consulted and the dam was built according to their
plan “the dam did not give way” (CW 9: 599). While the irri-
gation problems at Pune were not entirely solved by this dam,
the example shows Nightingale learning of the accomplish-
ments in engineering and even sanitary measures from native
Indians, whose industry and intelligence she came to value
privately long before her public accounts of the heroism of
the Indian peasantry. This example of native industry appears
never to have made it into Nightingale’s public writings on
irrigation in India.
Where the numbers provided by the sanitary statistics she
had collected in the 1860s would appear to provide a kind of
“slam dunk” case for advocating irrigation works, even over
and above railroads (whose advocates competed for govern-
ment funds), the public relations errors of one of Nightingale’s
chief allies in advocating irrigation works may well have been
one of the main factors that resulted in Nightingale’s decision
to frame her writings about Indian famine with an eye to
public sympathy and perception, rather than convincing num-
bers. Nightingale’s public involvement in the irrigation con-
troversy began with Arthur Cotton, Madras army engineer,
with whom she consulted closely in 1874–1876, whose address
to Parliament in 1877 insulted the India Office for its gross
mismanagement of water issues. He wrote:
[I]t does not take five minutes’ investigation to prove, indis-

putably, that the sole cause of the Famine is the refusal to
execute the Works that will give us the use of the Water that
is at our disposal. . . . When Railways were undertaken, a com-
plete project for all India was sketched out by the supreme
Authorities and not isolated patches. But no arguments were
sufficient to persuade the Authorities to set about this great
work of rescuing India from Famines, so that now we have
before our eyes the sad and most humiliating scene of magnif-
icent Works that have cost poor India 160 millions, which are
so utterly worthless in the respect of the first want of India,
that millions are dying by the side of them. Could there be
a more grievous proof of our strange want of wisdom in our
management of the Country of which God has been pleased
to make us Guardians? (Cotton, 5)
He went further to suggest not only that the India Office’s

mismanagement of colonial affairs was to blame for millions
of deaths, but that the government as a whole tacitly colluded
in that mismanagement: “We cannot therefore,” he argued,
“be surprised that the word Water has been so carefully left
out of the Indian discussions on the famine, in the House
of Commons and at Cooper’s Hills. . . . The main point of
all is this, that we have the most indisputable proof that the
Country must not leave the Famine in the hands of the India
Office” (Cotton, 5).
Nightingale supported Cotton’s assessment by republish-
ing a letter she wrote to the Editor of the Illustrated London
News, of June 29, 1877, as an appendix to Cotton’s essay. But
her letter took a different tone toward British involvement by
focusing on the immense successes of the Government irri-
gation works in four districts in Madras: Tanjore, Godavery,
Kistnah, and Kurnool: “A Missionary in the Godavery District
told Sir Arthur, that the scores of times the people had grate-
fully said to him ‘we never got the Godavery Water on our
lands till you Christians came here.’ Truly the Greatest Raj
is the English” (Nightingale, Cotton Appendix, 25–26). Was
Nightingale naïve and ill-informed about the inadequacy of

the Government’s commitment to irrigation works? Or was
she working to neutralize what she saw as the possible negative
effects of Cotton’s more strident critiques?
Writing to Chadwick in 1877, Nightingale says in her post-
script, “How I wish [Cotton] would not write in that style of
attack, setting every statesman and newspaper against him, so
that one does not like to appear in the same pages” (CW 9:
758–59). Yet she also chides Chadwick for not making clear
in the government’s sanitary report for India the extent of
Cotton’s authority over issues of irrigation: She begins by cri-
tiquing Chadwick’s seemingly innocuous wording of the fol-
lowing clause: “ ‘Sir Arthur Cotton has also advocated’.” She
explains “Sir Arthur Cotton, the master, almost the father in
modern times of the art of irrigation, . . . You cannot say of such
a master, he has ‘advocated’; and to say of him “also” is like
saying . . . Mr. Edwin Chadwick has ‘also advocated’ sanitary
measures” (CW 9: 758). While her private view of the irrigation
problem likely agreed with Cotton’s, her public advocacy struck
a more congenial tone. Her tone here, of course, is in marked
contrast to the chiding tone she will address to the British pub-
lic in 1878. What, besides desperation to evoke sympathy on
the part of the British, would account for her change of tactic?
When she herself published a feature essay focused entirely
on the issue of irrigation in 1878, she chose a literary approach
to her argument, one that offered to the reader possibilities for
viewing themselves and their government in a heroic light. In
“A Water Arrival in India,” published in the popular journal
Good Words, she likens a government report about the effects
of the opening of a government engineering works in the
Hooghly district to the plot of an epic poem.10 The essay stra-
tegically frames several quotes from the report describing the
works. The report describes how the works restored a fifty-
seven mile long river that had silted up in drought between
the Damoodah and the Hooghly district. Nightingale, how-
ever, creates a narrative through which those British readers
willing to invest themselves in agitating for the famine relief
effort might be able to imagine themselves—along with their
government officials who supported irrigation works—in the

role of the epic poem’s hero-lover. The essay begins with the
epigraph “The Bridegroom cometh” (Matthew 25: 6) and con-
tinues as follows:
An Indian famine: . . . men, women and children, as well as

cattle, perishing for want of water and food, strength ebbing
away, people living, or rather dying, on weeds, on jungle pro-
duce perhaps.
A royal progress. Like an epic poem the hero-lover meets his
people and his lady love; he has delivered his country from the
destroyer[.] (CW 9: 771–72)
Interestingly, Nightingale identifies the “author” of the epic

poem she describes as Buckland, the commissioner of the
Burdwan division to the Bengal Government, under whose
governance the irrigation works were built. After quoting from
police accounts in Buckland’s report that “ ‘the inhabitants are
overjoyed,’ ‘praising the English government.’ ‘It is a gift from
God.’ ‘They were “badly off” (badly indeed) for water, but
now they have full and plenty,’ ” Nightingale concludes, “Is
not Mr. Buckland an epic poet without knowing it?” (CW 9:
773). But the highly idealized scenario (not to mention the
playful rhyme) may also serve as a reminder that Nightingale
depicts this example of successful government intervention
four years in the past as still a kind of dream, rather than a
reality for most of the Indian population. Nightingale ends
“A Water Arrival in India” by turning her reader’s attention
to the as-yet-unsuccessful efforts of the Ryots of Trichinopoly
in November 1877 to get the governor of Madras to invest in
similar irrigation works for them. The failure of their efforts
was particularly tragic given that the Ryots had themselves
subscribed toward getting the irrigation works they so des-
perately needed. Nightingale closes with a paternalistic image
of subservient and patient peasantry. “And with picturesque
and pathetic simplicity, they pray for these to be carried out.
This is paper and words to us; to them life instead of death.
Such are two or three instances of bringing life out of death to
our neighbor in India. ‘Go and do ye likewise’.” (Acts 17–11)

(CW 9: 777) Appealing to national pride here, as elsewhere, is
for Nightingale a narrative and rhetorical strategy designed to
engage her reader before providing the more potent informa-
tion and instruction with which her essay concludes.
Writings of the late 1870s: Narratives,

Numbers, and Souls
The happy story of Burdwan success (mentioned above) which
Nightingale had used to agitate for further irrigation works
in India ultimately ended badly in life, if not in her narra-
tive. After publishing “A Water Arrival in India” it became
clear to Nightingale that even where water supplies existed,
moneylenders and Zemindars denied the poor adequate water
supply for survival. In “The People of India,” she acknowl-
edges this additional hardship: “In Burdwan in 1876–77,” she
wrote, “the lieutenant governor’s reports say that the country
was prosperous. Does the ‘prosperity’ then find its way into
the pockets, or rather first into the stomachs, of the people?”
(CW 9: 784). This question introduces a comparison between
the average diet of the Ryot, the Hindustani Sepoy soldier,
and the English laborer, in which, of course, the Ryot’s diet
by (any) comparison was pitifully inadequate.11 Nightingale
recognized that British policies supporting the exploitation
of Ryots by moneylenders and the Zemindars also prevented
any sanitary or irrigation improvements from providing the
heroic rescue from famine that she had previously envisioned.
In her words, “give the Ryot water and the profit will all go
into the moneylender’s pocket. Into his hands the ancestral
lands seem in danger of passing, and the Ryot of becoming,
not metaphorically, but in some cases literally and legally, the
moneylender’s slave” (CW 9: 787). This recognition may well
have led to the spirited, no-holds-barred critique that followed
in her next publication, “The People of India.”
Another factor that may have contributed to her change
of tone was that around this time, she began increasingly
to establish contacts with Indian natives.12 In 1869 she was
elected honorary member of the board of the Bengal Social

Science Association (BSSA), whose members were comprised
of both native Indians and British interested in the practical
application of sanitary measures in their own cities and vil-
lages. Her address to the BSSA in 1870 was her first work
addressed to Indian natives. Copies of some of her Indian
writings were read to the association, and, of course, this may
have prompted her decision to change the tone of her writ-
ings on India from the colonialist and nationalist tone of her
earlier writings.
Determining how her membership in this association
may have impacted her views of Indian problems is com-
plex. According to Gourlay, nineteenth-century Bengal was
“a breeding ground of societies, associations, and organiza-
tions. . . . They were the natural offspring of English educa-
tion introduced in Bengal and the social awareness[,] . . . in
places where the English educated elite of Bengali society,
the ‘enlightened Baboos’ met British liberal administra-
tors and missionary philanthropists for cultural exchanges”
(Gourlay, 92)13 Through her interactions with the BSSA
members, Nightingale grew to share the dissatisfaction with
British education in Bengal already expressed by Reverend
James Long, one of the founders of the BSSA, and fellow
BSSA member, missionary Mary Carpenter. Nightingale had
advocated for education in “European literature and science”
in her 1863 descriptions of the improvements offered native
Indians (in “How People May Live,” 191). But she came to
agree with Long and Carpenter that the focus of English ed-
ucation was on matters totally alien to much of the Indian
population. It was not focused on practical matters, and was
directed entirely to the urban upper classes.14 Her critique
developed in part from her own recognition of the ways the
socio-economic situation of the Ryots made sanitary efforts
futile if the other social and economic factors affecting their
lives weren’t dealt with as well. By the late 1870s she had
established new attitudes toward the English moral obliga-
tions in India and new priorities and strategies for achieving
her goals. Firstly, she began to solicit from her acquaintances
and friends among the Indian natives true stories of indi-

vidual suffering as a result of tenancy and irrigation prob-
lems. Writing to her friend P. K. Sen in 1878, Nightingale
explains the thing she thinks will be most effective in agi-
tating for the ryots:
I would earnestly request you to put down narratives of indi-

vidual ryots (with time, name, and place) in this connection.
English people will not read reports in general nor generali-
ties, abstractions, statistics or opinions, such as most reports
are full of. They want facts: individual facts concerning partic-
ular instances, real lives and effects.
Give us detailed facts. We want to rouse the interest of the
public. For behind the Cabinet in England always stands the
House of Commons, and behind the House of Commons
always stands the British public. And these are they we want
to interest, and these can only be interested by narratives with
real lives. (CW 10: 504)
This strategy of trying to familiarize the British public with

the ryots in order to elicit compassion for their plight was
complimented by another strategy, one we associate with a
sociological impulse. She tried both to show and create visual
images of the ryots in order to force British subjects to “see”
the devastating consequences of famine on human lives. This
strategy may well have evolved from Nightingale’s own expe-
rience. In 1877, one year before her public accusation in “The
People of India” and a month after her published letter to
the Lord Mayor, she wrote to British sanitary reformer Edwin
Chadwick:
My mind is full of the dying Indian children, starved by hun-

dreds of thousands from conditions which have been made
for them, in this hideous famine. . . . How I wish that someone
would now get up an agitation in the country, which shall
say to the government, “you shall,” as regards Indian fam-
ines and the means of preventing them, among which irri-
gation and water transit must rank foremost. If we had given
them water, we should not now have to be giving them bread.

(CW 9: 757)15
The connection her letter makes between her mental image

of dying Indian children and her wish for “someone . . . [to]
get up an agitation in the country” was one that she would
increasingly make as her commitment to advocating for the
Indian poor grew. Instead of producing statistical tables, as
she had done in her previous sanitary work, she came to see
the value of producing mental images with which to haunt the
consciences of proud English subjects. Focusing on individual
lives would allow her to make of faceless numbers, familiar
human faces.
Nightingale solicited narratives about the lives of the ryots
from the native Indians with whom she had developed acquain-
tanceships and even friendships. But the emotional power of
those narratives seems to derive at least as much from her own
methods of storytelling and reporting as they do from the facts
of the stories she tells. I have found no direct evidence in her
correspondence to confirm or deny that Nightingale drew spe-
cifically from the narrative strategies of condition of England
novelists as she wrote the ryots’ stories in the interests of rais-
ing British sympathies toward them. But, I find many narrative
features in common between the novels of Dickens and espe-
cially Gaskell, and Nightingale’s stirring 1870s essays on Indian
famine, particularly “The People of India.” Moreover, I find far
less to compare between Nightingale’s portraits of the ryots’
plight and the sparse accounts of the Indian peasantry con-
tained in the works of Victorian British travel writers in India.
Having witnessed the brutal treatment in the Anglo-Indian
press received by Russell in the late 1850s, as he tried to write
even-handedly debunking some of the worst rumors of native
violence against Anglo-Indian women following the 1857 mu-
tiny, Nightingale likely recognized that her own position in
critiquing British governance in India was a tenuous one. Her
position was more akin to that of authors writing sympatheti-
cally about the working classes during times of open hostility
between the classes (namely, in the 1840s and 1850s).
Nevertheless some consideration of the possible influence

travel writers to India may have had on Nightingale’s represen-
tations of the Indian peasantry seems necessary here. After all,
as Indira Ghose describes, much of Victorian travel literature
about India was written either by colonial administrators, who
“focused on surveying the country” in an almost ethnographic
fashion, sometimes even disguised in native attire (Ghose,
Intro. Travels, Explorations, Empires, ix ). Female travel writers
tended to be the wives, sisters, or daughters of military men or
colonial administrators.16 Women travelers in India however,
were mostly sheltered during their travels. As the accounts of
writers such as Emily Eden and Fanny Parks illustrate, they
had little access to the Indian peasantry and they seldom wrote
about them with any level of specificity (Ghose, Memsahibs
Abroad, 7).17 Those narratives that were written by women
in the wake of the 1857 mutiny say little about the peasantry,
as they “focus on the day-to-day tactics of survival,” accounts
that do not support the myth that English women were sub-
ject to rape and mutilation during the mutiny (Ghose, Intro.
Travels, Explorations, Empires, xix).18 Their travels were often
accompanied by enormous entourages whether traveling by
rail or over land, often by elephant.
One would think, given her own proto-sociological impulses
that the ethnographic representational strategy that many
of the male travel writers adopted would have appealed to
Nightingale. However, as we saw in Nightingale’s writings on
poor law reform, she appears to have cared little for sensational
journalism performed by workhouse visitors who attempted
to “pass” as “amateur casuals” to gain “accurate” pictures of
life in the workhouse. Moreover, I have found little evidence
either in my own archival research or in the immense amount
of public and private writings made available in the two vol-
umes of The Collected Works of Florence Nightingale devoted
to her work on India (Volumes 9 and 10) to suggest that
Nightingale thought much of or even read some of the more
popular accounts written by male or female travelers in India.
For example, she never, to my knowledge, mentions either
Alexander Burnes’s Travels in Bokhara (1834) or Sir Richard
Burton’s Scinde, or, the Unhappy Valley (1851); both authors

dressed in native costume in order to gain access to places into
which Westerners generally were not allowed. Burnes, an officer
in the East India Company’s service, returned to London after
his travels, “was lionized in London society,” and his memoir
of his travel “turned out to be one of the most popular travel
accounts of the time” (Ghose, Travels, Explorations, Empires,
xiii). Burton, at one time an officer in the Indian Army in
Gujarat, though he never saw military action there, famously
traveled in disguise throughout several regions in the East.
Though, as Ghose says, he “probably spent a large part of the
seven years he was in India (1842–1849) working as an under-
cover agent in disguise” (xiv), he wrote little about the period
in which he worked in disguise in his book on Sind.
The only travel writer about whose work on India
Nightingale writes with admiration is William Sleeman, who,
unlike Burnes, Burton, and others, traveled without disguise
in India. He wrote sympathetically of the plight of poor Indian
peasants vulnerable to freebooters and corruption in the Oudh
region. Nightingale appears to have read this work, since she
wrote admiringly of his writing that “we have only to look
at the book of Colonel Sleeman, the British resident, written
after he had made an official tour through the country, to
see what these talukdars are” (qtd. in CW 10: 410). Talukdars
were “revenue collecting intermediaries (ex-warlords) in the
N[orth]W[est] Provinces and Oudh, confirmed by the British
as landlords” (CW 10: 924). Nightingale gave perhaps an even
more ringing endorsement of Sleeman’s work in 1879. When
trying to find someone to write the biography of her hero
Sir John Lawrence, whom Nightingale and others credited
with helping prevent the spread of the 1857 Mutiny to the
Punjab,19 “a memorial” she felt was “of more importance than
perhaps any other,” she thought of Sleeman. After asking her
correspondent, “Where are the Indian heroes who shared his
[Lawrence’s] labours and who are also writers?” she lists among
a select few others “Colonel Sleeman” [who] was a great writer
but he is dead, is he not? (CW 9: 630). Though Sleeman pro-
vided narratives of, for example, the barbarous behavior of an
amoral and ruthless revenue contractor, and a happier portrait

of native lives under an uncorrupt contractor, stories which
bear some similarity to the narratives Nightingale would pro-
vide to her readers twenty years later in “The People of India,”
he told his stories with his focus on the differences between
corrupt and moral leadership in regions of Oude, rather than
detailing the lives of the peasants themselves. This passage
from A Journey through the Kingdom of Oude goes further
than most in providing information about the lives of the
peasantry, but even here, there is little sense of the peasantry
as individuals or even as a group with a sense of agency: “The
landholders and peasantry seem all happy and secure under
their present masters, the brother and son of the late Dursun
Sing. They are protected by them from thieves and robber, the
attacks of refractory barons, and above all, from the ravishes
of the King’s troops” (Ghose, 188). Of course Sleeman’s book
was written in part to influence the government to change
its policies in ways that benefited the peasantry. And accord-
ing to Indira Ghose it was privately published in 1852, prior
to the period of Russell’s Crimean war writings and their
effect on reformist journalism, and the eighteen copies were
circulated among government officials. Nightingale admired
Sleeman’s reformist motives, but when it came to making her
case to the public in 1878, she needed to create narratives that
would focus readers’ attention on—and raise their sympa-
thies for—the Ryot population, about whom they knew little
and with whose sufferings they were apparently unwilling to
sympathize.
Raising Sympathies: Advocacy

and Information
For her most aggressive assertion of English moral account-
ability for the famine in India, “The People of India,”
Nightingale chose strategies akin to the most striking passages
in Condition of England novels: establishing a tone of sympa-
thetic advocacy toward the working poor, invoking images of
starving children, and positioning her narrator as an authority
through her access to “real lives” and eyewitness testimony.

These and other narrative techniques including the strategic
use of inexact numbers to describe scenes of mass suffering
helped her to draw striking points of comparison and contrast
between the behavior in hardship of the Indian poor and the
English urban poor, as well as establishing further connec-
tions between Indian peasant life under the English Raj and
the (recently abolished) practice of slavery.20
Drawing from the narrative and rhetorical strategies of
the Condition of England novels of the “Hungry Forties” in
Britain allowed for Nightingale to invoke their familiar, devas-
tating portraits of starving individuals which had so effectively
raised readers’ attention toward the effects of the industrial
crises on the urban poor: overcrowding, unsanitary living con-
ditions, epidemic disease outbreaks, low wages, unavailability
of work, and starvation help fuel the political plots of these
novels. But these novels, Gaskell’s Mary Barton in particular,
also suggested that informed sympathetic reactions on both
sides—rich and poor—would quiet the anger of each toward
the other. The novels may well have provided a conservative
social function in quelling dissent; but they also drew popular
attention to the suffering of the many by utilizing a strategy
of moving between individuals and communities of sufferers.
Nightingale admired these novels and their writers: Charlotte
Brontë, Charles Dickens, and Elizabeth Gaskell in particular21:
Gaskell even wrote parts of North and South while staying at
the Nightingale home, Lea Hurst. She and Nightingale corre-
sponded about retraining Manchester needlewomen for work.
In January of 1979, just a few months after publishing “The
People of India,” Nightingale expressed in correspondence her
hope that “an Indian Dickens” would arise to raise readers’
awareness of social problems in India in the same way that
Dickens had in England. Despite her lively sense of humor,
Nightingale did not attempt Dickens’s kind of humorous social
satire through the use of caricature and sarcastic narration;
but she did use the techniques of sentimental and sympathetic
advocacy Dickens, Gaskell, and Brontë all utilized. More than
any other Condition of England novelist’s strategies, however,
in her most impassioned public document about India, “The

People of India,” Nightingale’s narrative strategies share fea-
tures in common with those Gaskell employed with great suc-
cess in Mary Barton.
Consider the following passage from “The People of India,”
written just one year after Nightingale’s letter to Chadwick,
quoted above, in which she claimed her mind was “full of
the dying Indian children.” Nightingale works to plant the
same tragic picture in her reader’s mind by alluding to “five
or six” photographs that she’s had sent to her of starving
Indian natives.22 At the same time that she asks her readers to
imagine images of starving people, she uses inexact numbers,
to distance her portrait from anything like the faceless statis-
tical accounting of the numbers suffering (what she refers to in
the following quote as “figures, paper and print”):
Between five and six millions have perished then in this Madras
famine. These are figures, paper and print to us. How can we
realize what the misery is of every one of those figures: a living
soul, slowly starving to death? I have had photographs sent me
of five or six. An infant with precocious resigned eyes of suf-
fering, a living skeleton in its mother’s skeleton arms, a dying
boy, a helpless old man, a man stricken down in the prime of
life. I could not bear to look at them. I hid them away and
would not publish them. But not five or six, but five or six mil-
lions lay down thus to die, slowly to die of hunger and thirst,
besides the millions who were saved. And when we realize that
five or six millions have so died—that we count not by fingers
of one hand but by millions, every finger is a million of living,
dying people—do we realize what it is to say that many more
millions have so lived, been so saved and will so live after the
famine, going back to their bare and roofless homes where not
a straw remains? (CW 9: 781)
The passage draws attention to the feelings of Nightingale her-

self in response to contemplating the numbers of famine casu-
alties and imagining the suffering selves of each. Ironically her
repeated use of inexact numbers (“five or six”) helps to sug-
gest something accurate about the overwhelming experience
of attempting to take in the numbers and attach to each a self,

a soul, a face. Certainly the description is designed to elicit a
response to the numbers more than a simple statistical table
would. One just can’t take the numbers in—one is reduced to
the absurdity of imagining in five or six photographed faces, 5
or 6 millions souls, or of seeing represented in one finger, mil-
lions of starving bodies. By admitting her own need to look
away from the images of sufferers and her subsequent deci-
sion not to subject her readers to the photographs (she “would
not publish them”), Nightingale emphasizes her own pain and
through her’s, the observing spectator’s prospective pain at
witnessing the “real” results of famine, as much or more than
the pain of the people in the photographs.
Compare this scene to one of the most famous and oft-
quoted scenes from Gaskell’s Condition of England novel,
Mary Barton (1848). While grieving the death of her young
son, Gaskell wrote Mary Barton in part, she claimed, because
she wanted the middle classes and masses of the industrial
poor in Manchester to come to a better understanding of one
another:
The more I reflected on this unhappy state of things between

those so bound to each other by common interests, as the
employers and the employed must ever be, the more anxious I
became to give some utterance to the agony which, from time
to time, convulses this dumb people; the agony of suffering
without the sympathy of the happy, or of erroneously believ-
ing that such is the case. (Preface)
Gaskell provides information for the middle-class reader about

the conditions of the Manchester working classes by depicting
a visit that two workers make to the home of a third mortally
ill co-worker:
As [the two workers] passed, women from their doors tossed

household slops of every description into the gutter. . . . Heaps
of ashes were the stepping-stones, on which the passer-by,
who cared in the least for cleanliness, took care not to put his
foot. . . . You went down one step even from the foul area into
the cellar in which a family of human beings lived. . . . After the
account I have given of the state of the street, no one can be
surprised that on going into the cellar inhabited by Davenport,
the smell was so fetid as almost to knock the two men down.
Quickly recovering themselves, as those inured to such things
do, they began to penetrate the thick darkness of the place,
and to see three or four little children rolling on the damp, nay
wet, brick floor, through which the stagnant, filthy moisture
of the street oozed up; the fireplace was empty and black; the
wife sat on her husband’s lair, and cried in the dank loneliness.
(Gaskell’s emphasis, Mary Barton, 66)
Much of the secondary criticism on Mary Barton has stressed

how similar this particular scene is to poor law medical officers’
accounts of urban squalor recorded in government blue book
reports. In Edwin Chadwick’s 1847 report on the Health of
Towns, for example, he describes the career of one such medi-
cal officer, and quotes from that officer’s reports: “In one small
cellar, with no window, [he counted] eighteen persons in fever,
lying in wet dirty straw. In one house he counted eighty-one,
in another sixty-one, in every stage of fever, on straw in the
corners. I believe these were (as I know one house with thirty-
one cases was) uninhabited houses, into which poor people
had crept for shelter” (6). Chadwick’s report stresses the exact
numbers of the inhabitants of cellars and houses (eighteen,
eighty-one, sixty-one) and includes little sense of the feelings
of the officer himself in response to what he witnesses other
than the evocative diction that imagines the “poor” inhabit-
ants have “crept” into the cellar.
Unlike Chadwick’s account, both Nightingale’s description
of the photographs of starving Indian natives and Gaskell’s
narrator’s descriptions of the Davenport cellar focus primar-
ily on the effects of the scene of suffering on its witnesses.
In Gaskell’s scene, the visitors are “inured” to the sights and
smells of abject poverty. The narrator’s brief switch to second
person—“you went down one step even from the foul area
into the cellar in which a family of human beings lived”—
puts the reader into the perspective of the first-hand spectator.
Nightingale employs a similar strategy when she switches the

point of view as she shifts from describing her own personal
reaction to viewing the five or six photographs of starving
Indian natives in the first person to describing “our” over-
whelmed reaction to the numbers of famine victims that those
five or six images represent (“And when we realize that five
or six millions have died”). In both cases a point-of-view shift
asks readers to experience a scene of suffering as if through the
eyes and with the feelings of the observer him or herself.
By the end of her paragraph about the photographs,
Nightingale has shifted her own and her readers’ focus away
from those “five or six millions [that] have so died” and instead
retrained her readers’ thoughts onto “the many more mil-
lions [who] have so lived, been so saved” (CW 9: 781). Out of
the image of overwhelming despair that she has just painted,
Nightingale subtly allows the prospect of heroism to develop
through the saving of countless lives brought about primar-
ily (though she does not say so specifically here) through the
sympathetic actions of government officials and philanthropy
of private individuals.
But Nightingale is also careful to ascribe to the Ryots an
attitude of self-help that she presents as perhaps an even nobler
kind of heroism to that practiced by the government officials
and philanthropists. To do so Nightingale turns to the sto-
ries of individual peasants struggling to survive in the wake
of exploitive money lenders. She introduces the stories with a
clear appeal to readers’ sympathies for the victims of money
lenders:
I come now to individual instances of moneylenders and their

victims. The first indication of what led to the Deccan debtor’s
riots of 1875 is so characteristic that I open with it, the saddest
series that ever fell to a peaceful periodical to give. It shows
that the victims of the Marwari moneylenders are not limited
to poor cultivators. (CW 9: 795)
The story of self-help that follows pits noble Indian native

peasants against crooked native money lenders. The story
takes place in the period leading up to the outbreaks in the

Pune and Ahmednagar districts. A deshmukh (district hered-
itary officer) named Baba Saheb, of good fortune and some
influence, settles in a village and “[falls] among thieves”
(Luke 10: 30), that is, into the hands of the Marwaris
(money-lending class). Nightingale details how Baba Saheb
and his neighbors band together and drive the Marwaris out
(CW 9: 796–97).
Gaskell’s condition of England narrative, too, brings the
reader’s attention to efforts of the poor community to take care
of its own. In doing so Gaskell addresses the middle-class fear
of able-bodied pauperism which dominated the anti-poor law
rhetoric of the hungry forties.23 Both Nightingale and Gaskell
worked to counter the impression that the poor wanted to
be paupers dependent on the state for their livelihood. In the
scene that follows George Wilson and John Barton’s efforts to
help Ben Davenport and his family during his crisis of fever,
Gaskell provides an example of those with very little trying to
look after those with nothing:
It was agreed that the town must bury him; he had paid to
a burial club as long as he could, but by a few weeks’ omis-
sion, he had forfeited his claim to a sum of money now. Would
Mrs Davenport and the little child go home with Mary? The
latter brightened up as she urged this plan; but no! where the
poor, fondly loved remains were, there would the mourner be;
and all that they could do was to make her as comfortable as
their funds would allow, and to beg a neighbour to look in and
say a word at times. So she was left alone with her dead, and
they went to work that had work, and he who had none, took
upon him the arrangements for the funeral. (81–82)
Gaskell’s reference to the man who takes on the funeral

arrangements because he has no job is emblematic of the
fact that none of the poor in Gaskell’s narrative are inactive
except for those who are incapable, through illness or star-
vation, of exertion. And even these seemingly unexceptional
characters have the capacity for heroism once rested and fed.
Later in her narrative Gaskell brings the reader’s focus back

to Mrs. Davenport, depicted in the earlier scene simply as
“the wife” crying helplessly by her dying husband’s side. She
returns to help care for the Wilson family when their twin
babies fall ill. Joseph Childers has described the “commu-
nity of suffering” that Gaskell presents as an example of the
heroism that comes from community care and responsibility
among the poor—from which example the reader might learn
and be inspired.24
In her account of the Indian peasants, Nightingale, too,
connects her examples of community care and responsibility
to middle-class fear of inadvertently producing able-bodied
paupers. In the process she produces a damning comparison
with the English urban working classes:
There is so little danger of pauperization that, in the Madras

famine, for one who threw himself without need on the relief
measures ten died in silence, almost unknown to our mas-
ters (not like the wolf, “biting hard”).25 There is such an ele-
ment of endurance and heroism that, quite unknown to our
masters, during the greatest starvation and the highest prices,
the hoarded grain remained in pits safe in the earth—none
betrayed the secret—hoarded, not to sell again at the high-
est famine prices, but for seed corn against another failure of
crop. . . . What thrift, what endurance, have we Westerns com-
pared with this? And we in the West preach thrift to them. The
“horse” literally “saved” his one straw a day for his children’s
sowing. And they call these people not thrifty. It is the very
heroism of thrift. Compare the people of some of England’s
big towns with their drunkenness, their vice and brutal crime,
their reckless waste and unthrift, with the industrious peoples
of India. Which is highest, even in the scale of civilization? A
question not to be asked. (CW 9: 792)
The Indian peasantry, she concludes, should be viewed by the

English reader as “the most industrious, the most frugal, the
most thrifty, one might almost say the most heroic, peasantry
on the face of the earth” (CW 9: 781). The repetition of the
adjective “industrious” can hardly be accidental, given the
comparison it helps imply between the poor in industrial cities

in England and the Ryots Nightingale wishes to laud in the
interests of engaging English readers’ sympathies.
Along with the strategy of contrasting heroic peasant thrift
to wasteful and indulgent English working-class behavior,
Nightingale makes the most of her strategy of linking the sit-
uation of the Ryots generally to the lived experiences of native
Indian children and, through them, experiences of children
generally. For example: Nightingale gives several specific
examples of missionaries’ accounts of young, famine orphans
looking after each other, being brought back from near-death
from starvation and disease through the exertions of their
fellow orphans. In an odd moment, Nightingale addresses
her reader as if acknowledging the possibility that her reader
might find her appeal to their sympathy through accounts
of children suffering to be clichéd, a strategy with which
they might be familiar from novels such as the Condition
of England novel. She writes, “Little ones who had no little
foster mothers wandered about to get a dole of food from
any one who would give, then lay down and died with—pass
me the word—the heroic agony of childish patience” (CW
9: 782). “Pass me the word” reads almost like frustration at
the inadequacy of clichéd language to express the tragedy of
the situation, but it may also mark her acknowledgement that
she is falling back on novelistic, familiar language in order to
draw her readers into sympathy with the children. Nightingale
insists that the feelings of children be pushed into the readers’
consciousness in a fashion that generalizes about suffering,
subtly erasing racial, class, ethnic, and religious differences
between individuals:
As certainly the sufferings of children, though no whit less

patiently borne, are more severe, more agonizing than those
of grown-up or old people: for children cannot look forward,
cannot understand, can feel nothing but the cruel suffering
and weariness of dying, cannot measure the time or see the
end. As a child who had fallen into a ditch for one minute said,
“I was there for a thousand years.” (CW 9: 272)
Interestingly, this suffering child’s words and thoughts are

recorded, unlike the Indian children and adults in the photo-
graphs, but his or her race, gender, religion, and class are not
identified. Presumably, however, this child’s experience can
speak to something typical about the suffering of all children,
and even all sufferers.
This account, too, is reminiscent of a moment in Mary
Barton where an anonymous child complains of his intense
hunger to the titular heroine as she passes him in the street.
Mary’s reply to the child’s complaint is that “hunger is noth-
ing,” presumably compared to emotional suffering (such as
that Mary is currently feeling). Mary’s reply may suggest that
Gaskell wishes to put that child’s physical suffering into a
context of some kind of greater communal emotional suffer-
ing that the middle-class reader might more nearly identify
with—but it also suggests that Mary, who does “clem” (starve)
in the novel, but not until later in the narrative, is in danger
of forgetting the material conditions of the actually starving
children, with whom readers too might not so readily wish
to be faced or forced to identify. The narrative remains with
Mary (it follows her back to her home and her worsening eco-
nomic and emotional conditions there), and never circles back
to the fate of the starving child Mary encounters (as it did in
the case of Mrs. Davenport). We can probably read this as a
sign of Gaskell’s resistance to turning her readers’ attention
for too long away from her heroine and the narrative’s trajec-
tory toward the marriage plot that will eventually move her
out of the working classes and into the middle class after her
marriage and emigration to Canada, an ending that effectively
erases the tensions raised in the political plot involving work-
ers’ agitation for the People’s Charter.
Without the strictures of a marriage plot, Nightingale works
to find other possible ways of resolving the probable tensions
her attack on middle-class apathy toward Indian suffering has
almost certainly raised in readers. In accomplishing this goal,
too, Nightingale’s narrative strategies appear to draw from the
strategy of sympathetic advocacy with which Gaskell intro-
duces Mary Barton. In that Preface Gaskell suggests that what
will alleviate the frustration and anger of the working classes

about their dire conditions of poverty is for them to feel that
the middle class recognize and sympathize with their suffer-
ing. Here Gaskell hedges on whether or not the working clas-
ses are right to assume the apathy of the middle classes:
If it be an error, that the woes, which come with ever-returning

tide-like flood to overwhelm the workmen in our manufactur-
ing towns, pass unregarded by all but the sufferers, it is at any
rate an error so bitter in its consequences to all parties, that
whatever public effort can do in the way of legislation, or pri-
vate effort in the way of merciful deeds, or helpless love in the
way of widow’s mites, should be done[.] (xxxvi)
Nightingale’s first address to the British Social Science

Association in 1870 had stressed too “the great interest now
felt by public opinion in England in the health, both physical
and social, of those to whom we truly feel as to our beloved
brother-and-sister subjects in India” (CW 10: 236). Now, by
introducing her essay in the Nineteenth Century, a widely read
liberal journal, with the blunt statement “We do not care for
the people of India,” Nightingale was taking Gaskell’s strategy
of asserting the appearance of middle-class apathy one step
further.
But the rhetorical strategy of accusation with which she
begins “The People of India” gives way to a narrative that
engages readers with accounts of the noble struggles of Indian
natives. In shifting focus, Nightingale is able to prompt her
reader into a kind of sympathetic identification with the suf-
fering of Indian natives. She, meanwhile, presents her reader
with a complex account of why, despite the Ryots’ heroic
efforts and the best of English government and philanthropic
interventions on the Ryots’ behalf, the Ryots were still left vul-
nerable to famine. Though she took flak from the India office
for the essay—some officials at the office apparently called it
a “shriek”26 —she actually does, later in the essay, give credit
to “the unflinching courage and honesty of the government
and every official under it in trying even more than man can
do to keep to its purpose of not allowing one famine death.”

She credits as well “England and the colonies vying with each
other in coming to the rescue by a voluntary subscription of
about ₤800,000, in distributing which all classes in Madras,
European and native, worked hard and well and to the best
purpose” (Nightingale, 10: 780), apparently contradicting the
accusation of apathy with which she began the essay.
In actuality the narrative that follows her accusation of
English people’s lack of feeling for Indian natives, serves to
answer the question she asks at the end of the first paragraph
of the essay: “how else [besides the public not caring for the
people of India] to explain the facts about to be presented?” Just
as Gaskell gives her middle-class readers an “out” by claiming
that the poor are mistaken in believing that the middle class
don’t care about their plight, Nightingale’s essay too gives her
readers an “out.” The essay eventually identifies a villain on
whom the reader can blame the worst of the economic ineq-
uities suffered by the Ryot: the moneylender and landlord—
native Indian or European. Having given the reader an “out”
from the charge of not caring, she then insists that her reader,
having been provided with stories of how suffering is perpet-
uated by money lenders and exploitive Zemindars, must come
to view inaction to curb the exploitive actions of moneylenders
as being comparable to inaction to stop slavery:
The great moneylending question: how to give the Ryots, esp-

ecially in southern India, just and legal help against the mon-
eylender? Otherwise, give the Ryot water and the profit will all
go into the moneylender’s pocket. Into his hands the ancestral
lands seem in danger of passing, and the Ryot of becoming, not
metaphorically, but in some cases literally and legally, the mon-
eylender’s slave. We now give the moneylender unjust and legal
help to possess himself of the lands of India and to make the
ancestral cultivator and the rude tribes his slaves. (CW 9: 787)
Britain had abolished slavery in her colonies in 1833, though

enforcement of the new law took some time. The act none-
theless allowed England to claim moral superiority to the
United States. So Nightingale reinforces the comparison

between failure to act in support of the Ryots and failure to
act against slavery. She even suggests that the money lenders
have, in squirreling away the peasants’ livelihood, diminished
the shine of Britain’s “jewel in the crown.”:
Is it not strange that, under a country boasting herself the

justest in the world and the abolisher of the slave trade, a pov-
erty, an impecuniosity, an “impropertyness” leading to virtual
slavery, should be growing up—actually the consequence of our
own laws—which outstrips in its miserable results, because it
enslaves and renders destitute a land-possessing peasantry (in
southern and western India), anything except the worst slave
trades? And in some respects things are done under us, though
not by us, almost as bad as under the tax-farming Turks. . . . The
British Government does “allow slavery,” though not by act
of Parliament, nor by act of legislature of the Government of
India, nor of the Viceroy-in-Council, but rather by want of
act. And the instances where the slaver is discovered and not
allowed are the exception, and the instances where it reigns
rampant are the rule. (CW 9: 803–4).
The strategy of holding English law responsible for the enslave-

ment of its own colonial subjects in India leads Nightingale
into her final rhetorical coup de grace—Nightingale can now
show the devastating consequences of English failure to prevent
famine without (she appears to have thought) alienating her
readership. The English government and press had not given
the English public an adequate portrait of the causes of famine,
the suffering of the population under it, and the extent to which
the Indian natives were deserving of English agitation on their
behalf. In describing the reaction of the English press to the
famine deaths, Nightingale draws a striking contrast between
the way the English media presented the value of an English
poor person’s life relative to the value an Indian peasant’s life:
One death from starvation in London fills all the newspa-

pers with reports of the inquest upon the body. There is a
machinery which costs us seven millions of money a year to
prevent it. Public opinion is now holding—holding, did I say?

It is not holding, it ought to hold—a gigantic inquest upon
6,000,000 bodies, dead less indeed by our fault in sparing
effort than in spite of every effort to save them from dying of
famine, to save them, not to prevent famine. (CW 9: 780)
Tracing how Nightingale adjusted her narrative and rhetori-

cal strategies to respond to famine reveals an amazingly nimble
mind as well as her willingness to address social problems in
deeply practical, as opposed to ideologically committed ways.
Both her public and private writings, if read in isolation or
out of their historical context, can produce a picture of her as
more conflicted about the changes she wanted to see in India
than I suspect she really was at any given period. The narra-
tive that I have created from her private and public writings
does reveal her movement away from her earlier nationalist
defense of English moral stewardship in India to her advo-
cating Indian home rule. Her increased understanding of the
economic causes of famine and her increased communication
with native Indian people appear to have prompted this shift
in her views.
What is equally apparent and perhaps more surprising is
that as her views changed, so too did the narrative and rhetor-
ical strategies she was willing to utilize for achieving her goals.
When she realized the necessity of moving her reader toward
sympathetic identification with Indian natives, she called on
proven strategies from crises in the past. The similarities be-
tween the narrative strategies of her late 1870s writings on
India and Gaskell’s in Mary Barton speak to Nightingale’s
ability to recognize how public fears might be soothed by pa-
ternalistic calls for sympathetic identification with sufferers,
while at the same time insisting on the heroism of those who
struggle to take care of themselves and their community. Her
recognition of the power of narrative to accomplish such goals
helped produced some of her most complex narrative and rhe-
torical strategies in her writings on famine, poverty, and dis-
ease prevention and relief in India.
Epilogue
Nigh t i ng a l e i n t h e Tw e n t y- f i r st
C e n t u ry : Th e L ege n d v e r sus
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 cen-
tury. There is no one way to describe her complex legacy. The
breadth and depth of her knowledge about social problems
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
efforts. Perhaps it’s then no wonder that in 1999 Unison,
the largest British trade union representing nurses, decided it
was time to disassociate their profession from her example, to
“exorcise the myth of Florence Nightingale” (qtd. in Bostridge
545).1 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 opin-
ion 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 per-
ceptions 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.2 Her insightful and thorough
methods of gathering information and her gifts for present-
ing 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”
N i g h t i n g a l e i n t h e Tw e n t y - F i r s t C e n t u r y 149
than the voluminous amounts of work she did in the inter-

ests of making life better for the poor, sick, and the colo-
nized. 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’s3; and I regret that crit-
ical attention on her life 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.
I hope that my efforts to situate Nightingale’s work within
the literary context of popular and reformist novelists who
addressed mid- and late-Victorian health and social problems
helps to bring Nightingale, the person, the intellectual, and
the reformer, more prominently into view. How Bostridge’s
reviewer in The Atlantic would find unenticing the prospect
of meeting Nightingale, the person, particularly given the
quality of Bostridge’s account of her life, also seems to me a
puzzling commentary on what contemporary readers admire
in public figures. Leaving aside for a moment Nightingale’s
intellectual brilliance and steadfast commitment to deeply and
broadly investigated reformist ideals, the fact that so many in
the literary, philosophical, political, and public health com-
munities respected and befriended her—among them Gaskell,
Mill, Jowett, Sir John Lawrence, Martineau, Quetelet, P. K.
Sen, Eliot, Chadwick—suggests that Nightingale may well
have been as engaging a person as she was a socially and politi-
cally informed one.
Of course, her legacy appears not just in her own volumi-
nous writings, but in the ways we read her influence in the
works of writers whose works bear signs of her influence. In
reading these works I find one possible explanation for why
Nightingale’s legend (whether the sympathetic or the bureau-
cratic legend that surrounds her) obfuscates for so many
contemporary readers the impact of Nightingale’s behind-the-
scenes and public reformist work.
To provide a brief illustration, take two early twentieth-

century examples of works that bear signs of Nightingale’s
influence, each published within three years of Nightingale’s
death and within a year of each other. The first is a novel,
Between Two Thieves (1912); the other, The Silent India: Being
Tales and Sketches of the Masses (1913), is a memoir and a work
of social history.
The heroine of Between Two Thieves by Clothilde Augusta
Inez Mary Graves (1863–1932), writing under the pseudo-
nym Richard Dehan, was to all the novel’s critics recogniz-
able as Florence Nightingale. I am less interested here in the
plot of Dehan’s novel, which revolves around an ill-fated love
between Ada Merling (the Nightingale figure) and a worthy
suitor, than I am in how its critics reviewed it based on its rep-
resentation of its heroine. After a brief introduction compar-
ing Dehan’s narrative style to the “Declamatory, caricaturing
mood of Dickens,” a reviewer in The Athenaeum turns to the
subject of characterization:
None of the characters is at all real, and most readers will feel
hurt at finding in the heroine of a romanticized unhappy love-
story a portrait plainly intended for Florence Nightingale. It is
a pity that so much imagination and labour as have evidently
gone in to the making of this book should run to waste for
want of restraining taste and sobriety.
Clearly three years from Nightingale’s death, the reviewer

expects that the public will resent the trivializing of
Nightingale’s story into one of failed romance for sensa-
tional ends.
Where The Athenaeum reviewer assumes that the reading
public will view the trivialization of Nightingale’s life story as
reflecting a lack of “restraining taste and sobriety,” a reviewer
for The Bookman views the novel’s portrait of its heroine as
failing to live up to the luster of the original:
In one important instance the appeal of our author to the

past is unmistakably intentional; Ada Merling, with her home
for governesses and her visits to the Institutions of Lutheran

Deaconesses and the Sisters of St. Vincent de Paul, is a fairly
close copy of Florence Nightingale. Observe the names. This
is bad technique. The heroine inevitably loses much of her per-
sonality in the shade of her great exemplar.
This reviewer lauds Dehan for “appreciat[ing] nobility of char-

acter, and carr[ying] the reader with her” in that appreciation;
but at the same time he or she concludes that the novel ulti-
mately fails on account of the number of melodramatic episodes
“only too redolent of the French stage.” For both reviewers
Dehan fails the test of realism. The Athenaeum reviewer goes
further in seeing the portrait of Ada as demeaning to the legacy
of Nightingale. For The Bookman reviewer, even a melodra-
matic portrait can’t match the “personality” of the original,
Nightingale. My purpose in citing these reactions is twofold:
first, I want to note how much admiration there appears to be
for the person and the personality of Nightingale reflected in
the reviewers’ comments, in marked contrast to the contem-
porary reviewers’ comments I have cited here; and second, I
want to contrast the views that appear in this novel and its two
reviews with the sense of Nightingale’s legacy that we might
infer from the work of Samuel Thomson (1853–1925).
Thomson’s The Silent India: Being Tales and Sketches of the
Masses makes no direct mention of Nightingale or her work
in India. Thomson may not have known her work, though
this seems unlikely given that he served as Deputy Sanitary
Commissioner, and then Sanitary Commissioner with the
Government of the United Provinces during a time when
Nightingale was still actively involved with work in India
(1895, 1902). Nevertheless, the narrative strategies by which
he attempts to address socio-economic and health problems
among the Indian peasantry so clearly resemble her strategies,
from his focus on “tales and sketches” of “real” native peas-
ants, to his invocation of Condition-of-England novel tropes,
that I find it hard to imagine that the legacy of her writing
on India is not felt in Thomson’s work, whether directly or
indirectly.
The Silent India: Being Tales and Sketches of the Masses

assures British readers that there are “Two Indias”—
the India of the large towns from which the casual visitor
draws his impressions, and which with considerable clamour
voices the aspirations of perhaps a tenth of the total popu-
lation of the country; and the India—the real India—of the
silent millions who lead a simple rural life, contented with the
thoughts and occupations of their forefathers, inherited from
the distant past. This is the population of which only the expe-
rienced Anglo-Indian has any real cognizance, and it is from
long contact with this that he principally derives those feel-
ings of kindliness and sympathy which make for friendship
and esteem between the races.
As I suggested of Nightingale’s language in her writings about

Indian famine, Thomson’s language, too, evokes the Condition
of England novel, in this case Benjamin Disraeli’s 1845 novel
Sybil in which he writes that England consists of two nations,
rich and poor, “between whom there is no intercourse and
no sympathy; that know nothing of each other.”4 “An Indian
Village,” the book’s first chapter, tells stories of individual
Indian peasants’ lives, as Nightingale does in “The People of
India.” And Thomson too stresses the “industrious[ness]” and
“thrif[t] of the native Indian worker. Thomson’s work never
acknowledges any direct debt to Nightingale’s, but in the ways
his rhetorical strategies (intentionally or unintentionally) res-
emble Nightingale’s, his work seems to reflect, far more than
Dehan’s fictional homage, how much thought Nightingale
gave to making her work not only, in her view, spiritually and
philosophically sound, but also appealing to those whom she
needed to convince and inspire.
I hope that this book may help make some of the far-
reaching resonances of Nightingale’s work in the literature,
culture, and politics of her day more visible through the
shadow of the Nightingale legend. Though the legend will
assure that Nightingale will never be one of those remarkable
women who “lived faithfully a hidden life and rest in unvisited
tombs,” as George Eliot’s brilliant conclusion to Middlemarch

describes its heroine’s fate, my hope is that the Nightingale
legend does not live on at the expense of our ability to learn
from the details—the mundane, the mistakes, and the heroic
effort—of her remarkable life and work.
No t e s
Preface
1. Madonna has also to date adopted two children from
Malawi.
2. The portrayal of female celebrity champions of social causes
in the contemporary media can be damaging to their reputa-
tions too. Often the media dismisses even the best informed of
these activists as self-obsessed “do-gooders.” Summer Wood’s
essay on contemporary female celebrity philanthropists, “Egos
without Borders: Mapping the new Celebrity Philanthropy,”
cites Jolie and Melinda Gates as notable exceptions to what she
calls the new kind of uninformed “feel-good philanthropy” of
female celebrities. A recent episode of South Park provides a
potent example of the perils of maternal activism in its brutal
depiction of an overweight Struthers hoarding and then eat-
ing food that had been donated for distribution to starving
Ethiopian children.
3. For instance, in 1857 Nightingale commented to a friend that
nursing became a kind of vogue in the years following the
Crimean War; but that fad later created both benefits and
concerns for her when unsuitable middle- and gentry-class
ladies thought that sympathy would be enough to make them
good nurses. For more, see Poovey, Uneven Developments,
176–79.
4. CW 5: 737, n. 139.
5. Under the old Poor Law of 1601 the able-bodied, sick,
and aged poor had all been looked after by the parishes
who administered “outdoor relief.” Under the Poor Law
Amendment Act of 1834 or the “New Poor Law,” “out-
door relief” to the able-bodied poor was abolished, 650
Poor Law unions were established under the supervision of
Poor Law Commissioners in London, and those not able to
156 Notes
support themselves or their families were compelled to enter

the workhouse where they did menial work in return for
room and board. Family members were separated from one
another and living conditions were awful. When Dickens’s
father was sent to the workhouse when Charles was eight,
Dickens himself was sent to work in a boot-blacking
factory.
6. Anderson, 9–13.
7. In recognizing the ideal of the participant-observer Anderson
rightfully credits James Buzard’s work on ethnography and
Victorian literature. See Anderson, 16.
8. Helena Michie provides a rich theoretical treatment of the
processes through which women negotiate their identities via
a complex combination of efforts to identify themselves with
and differentiate themselves from other women (Sororophobia,
Introduction).
9. Nightingale, BM 43400, f.276; Poovey, Uneven Developments,
169, 175; Judd, 135.
10. Here and throughout the book, I draw from Robyn Warhol-
Down’s work on gender and narratology in Gendered
Interventions, Introduction.
11. See John Snow, On the Mode of Communication of Cholera,
and “On the Pathology and Mode of Communication of
Cholera.”
12. Nineteenth-century disease theories are an immensely com-
plex topic. Some nineteenth-century and recent scholarship
conflate the term “infection” with contagion; while others
conflate “infection” with miasmatic (environmental) dis-
ease origins. I explain this confusion and the significance of
Nightingale’s views on it in chapter 1.
13. Nightingale most likely was at Lea Hurst for only a part of
Gaskell’s stay, since Gaskell describes herself as having come
“at the end” of Nightingale’s “two week holidays” and later
letters indicate that Gaskell slept at least part of the time in
Nightingale’s own room. Throughout her stay at Lea Hurst,
Gaskell apparently elicited many stories about Nightingale’s
youth, activism, and reformist beliefs from Gaskell’s mother
and sister.
14. Gaskell, Letters of Mrs. Gaskell. Letter 211: 306–7.
15. Judd, 4, 156 n. 12.
Notes 157
Introduction
1. See CW 2: 44.
2. Even as insightful and detailed a work as Lauren Goodlad’s
Victorian Literature and the Victorian State makes no men-
tion of Nightingale as an influence on social reform move-
ments related to sanitation, health policy, the New Poor
Law, or philanthropy. Goodlad’s description (following Mary
Poovey’s) of the mid-century opposition between material-
ist, Benthamite, bureaucratic reform efforts versus Thomas
Chalmers’ efforts at moral improvement of the working clas-
ses (coupled with charity from the rich and the middle classes)
cuts across many of the issues on which Nightingale’s behind-
the-scenes interventions were influential, as chapter 2 illus-
trates. See Goodlad, 48–53.
3. Here I follow Amanda Anderson in using the term, “partici-
pant observer” which she relates primarily to Victorian realist
fiction. In the preface, I explain Anderson’s definition of the
term and how it relates to Gaskell’s perception of Nightingale.
See also Anderson, 3–23.
4. As chapter 3 will describe in greater detail, Catherine Judd
addresses Nightingale’s distaste for Middlemarch in her
fine book, Beside Seductions: Nursing and the Victorian
Imagination, 1830–1880. Judd’s reading, however, does not
address as I do the wider context of conflict among prominent
members of the mid-Victorian medical and reformist commu-
nities with regard to competing understanding of the causes
and means of transmission of disease and how those com-
peting understandings affected crucial decisions about gov-
ernment funding, reformist legislation, activism, and moral
authority. See Judd, 123–51.
5. See CW 9: 823; CW 10: 173, 679, and 444.
6. Here and throughout the book I follow Nightingale in using
the term “native” to distinguish British colonial inhabitants
of India from inhabitants of India of South Asian descent The
term “native” carries with it orientalist, if not racist, connota-
tions; I use it because I think it best conveys Nightingale’s
own complex, but ultimately forward-looking views about
race relations in nineteenth-century India.
158 Notes
1. Defending Home and Country:

Florence Nightingale’s Training of
Domestic Detectives
1. According to Freedgood, “the offered remedies are “short-
acting” because “the speed and thoroughness with which they
solve every problem opens up the possibility that these problems
are so threatening that their presence cannot be tolerated tex-
tually for longer than a paragraph or two” (Freedgood 47).
2. Showalter, 153–81.
3. Nancy Aycock Metz has linked the popularity of the early
Victorian sanitary tract—with its narrative style, “a peculiarly
Victorian form of travel narrative,” and meticulous attention
to detail—to the success of early-Victorian mystery novels and
later sensation fiction (67). As far as I know, Nightingale does
not explicitly refer to the connection between the sensational
effects of both sets of texts.
4. See Nightingale, Annotations to Jowett, Introduction to The
Republic, 131–32.
5. As I discuss in chapter 3, this view is also presented by
Catherine Judd in Bedside Seductions: Nursing and the
Victorian Imagination, in which she describes Nightingale’s
dismay at George Eliot’s portrait of Dorothea Brooke in
Middlemarch; in Nightingale’s eyes, George Eliot failed in
Middlemarch to provide any potential outlet for Dorothea’s
heroic female spirit other than through influencing her hus-
band in marriage. See Judd, Chapter Six: “Nursing and
Female Heroics, George Eliot and Florence Nightingale”
(1835–1873): 123–52.
6. See Hume.
7. Nightingale wrote another version for members of the working
classes entitled, “Notes on Nursing for the Labouring Classes,”
Pamphlet, 1861.
8. See Thomas Southwood Smith, “Plague —Typhus Fever
—Quarantine,” 499–529. See also John M. Eyler’s discussion
of Smith’s strategy in Victorian Social Medicine.
9. Nightingale’s further claim that, “[w]ith proper sanitary pre-
cautions, diseases reputed to be the most ‘infectious’ may be
treated in wards among other sick without any danger” pro-
vides a sense of just how committed she was to her anticonta-
gionist views (Notes on Hospitals 10).
Notes 159
10. Eyler provides an excellent account of both Farr’s statistical

studies and his attempts to develop a nosology of diseases;
Eyler also devotes two chapters to a compelling description
of Farr’s relationship with Nightingale.
11. For a fine recent account of the debate around Nightingale’s
diagnosis, see Bostridge esp., 281–83.
12. For more on the sensation novelists and pre-Raphaelite
poets’ interest in following Ruskin’s “truth to nature” creed,
see Showalter. A great example of one Pre-Raphaelite artist’s
obsession with upholding the “truth to nature” creed is the
famous anecdote about William Holman Hunt’s “Light of
the World” painting, in which he forced the unlucky model
to stand in a chilly graveyard for hours, just so Hunt could
portray accurately the look of a freezing man.
13. For more on Chadwick, Kay, and moral contagion, see
Poovey, Making a Social Body 55–73; 98–114.
14. For more, see Poovey’s Chapter Six “A Housewifely Woman:
The Social Construction of Florence Nightingale” in Uneven
Developments, 164–98.
15. See Hugh Small Florence Nightingale: Avenging Angel.
141–44. Small cites two letters previously overlooked by his-
torians that indicate Nightingale’s struggle with the knowl-
edge that the mortality rate in her hospital was the highest of
any of the Crimean hospitals by a large margin largely because
they had not yet recognized that inadequate sanitation—and
not inadequate provisions and the weakened state of soldiers
transferred to Scutari—was the major cause of the high mor-
tality rate. In addition, he claims that the McNeil-Tulloch re-
port, which should have exposed this fact, was doctored in the
interest of preserving the honor (and the recruitment abilities)
of the British War Office (Small, 1–4). See James McNeil and
Alexander Tulloch. “Report of the Royal Commission into
the Supplies of the British Army in the Crimea.” Small argues
that Nightingale’s distress about the high mortality rate and
the government cover up explains her retreat from public life,
in any fashion other than commanding major figures in public
health to and from her bedside.
16. See Koch on Cholera in India and see Nightingale’s contribu-
tions on “Nurses” and “Nursing” to A Dictionary of Medicine:
Including General Pathology, General Therapeutics, Hygiene,
and the Diseases of Women and Children Vol. 2. [1882] Ed.
160 Notes
Richard Quain. For more on Nightingale’s late conversion to

germ theory, see McDonald, “Florence Nightingale and the
Germ Theory” and CW 9: 863–65.
17. See Maclean, Letter. Lancet 2 (October 29, 1870): 618–19
and Nightingale, Letter. Lancet 2 (November 19, 1870): 725.
2. On Giving: Poor Law Reform,

Work, and Family and in Nightingale,
Dickens, and Stretton
1. Remarkably, in this time frame (1860s–1870s), in addition to
her work on Poor Law Reform and India, Nightingale also
published work on other related subjects. These included works
on spirituality and religion, such as Suggestions for Thought
after Truth among the Artizans of England (1860), “A Note of
Interrogation” (1873) and “A Subnote of Interrogation” (1873);
a response to the Contagious Disease Acts, Notes on the Supposed
Protection Afforded against Venereal Disease by Recognizing
Prostitution and Putting it under Police Regulation (1863); as
well as a work on midwifery, Introductory Notes on Lying-In
Institutions (1871), and another on hospital statistics, “Proposal
for Improved Statistics of Surgical Operations” (1863).
2. See Review of Notes on Nursing, Notes on Hospitals, Care of
the Sick by Richard Barwell (112).
3. See Anonymous, “Miss Florence Nightingale.”
4. See Anonymous, “A Reverie after Reading Miss Nightingale’s
Notes on Nursing.”
5. On competition between Eliot and Nightingale, See
Catherine Judd, Nursing and the Victorian Imagination,
123–52. In using the term “sororophobic” I follow Helena’s
Michie’s coining of the term “sororophobia” to describe the
complex processes through which women in fiction and in
life negotiate their own identities through attempts to iden-
tify with and differentiate themselves from other women. See
Helena Michie, Sororophobia: Differences among Women in
Literature and Culture. Introduction.
6. By “affiliative family” I mean to refer to the family created by
affiliation—shared interests, concerns, and affection—rather
than by blood or romantic love. The residents of Bleak House
become a family because John Jarndyce essentially makes them
Notes 161
one when he becomes guardian to Ada, Richard, and Esther.

The term “affiliative family” appears to have been coined
in the 1970s. For more on its origins, see Sylvia Clavan and
Ethel Vater, “The Affiliated Family: A Continued Analysis.”
7. For more, see below and see also Dorice Williams Elliot,
The Angel out of the House: Philanthropy and Gender in
Nineteenth-Century England, 115–16.
8. Lynn McDonald kindly sent me lists from her archives of
references to novels compiled from Nightingale’s own lists of
works she read and/or donated to soldiers, nurses, and other
charitable institutions.
9. I am guided in this work by Seth Koven’s analysis of how the
phenomenon of “slumming” influenced the social scene in
London, Slumming: Sexual and Social Politics in Victorian
London.
10. Review of Notes on Nursing, Notes on Hospitals, Care of the
Sick, 108.
11. Ibid., 127.
12. Ibid., 127–28.
13. CW 5: 259.
14. According to Gillian Gill’s Nightingales: The Extraordinary
Upbringing and Curious Life of Miss Florence Nightingale,
Nightingale’s acquaintance with Jameson began prior to her
Crimean travels. Nightingale apparently tried to get informa-
tion from Jameson about a German woman who, unable to
work with Sisters of Charity because she wasn’t a Catholic,
nevertheless got permission from the physician of her town to
serve the poor in a nursing capacity (194).
15. Here is the longer passage from Middlemarch in which Eliot
describes with regret the lack of readers’ interest in stories of
vocation:
We are not afraid of telling over and over again how a
man comes to fall in love with a woman and be wed-
ded to her, or else be fatally parted from her. Is it due to
excess of poetry or of stupidity that we are never weary of
describing what King James called a woman’s “makdom
and her fairnesse,” never weary of listening to the twang-
ing of the old Troubadour strings, and are comparatively
uninterested in that other kind of “makdom and fair-
nesse” which must be wooed with industrious thought
162 Notes
and patient renunciation of small desires? (Middlemarch

Book 2: Chapter 15: 139)
16. Undated note, Add Mss 45845 f2; CW 8: 94.
17. Helena Michie details the association between female sex-
uality and work in The Flesh Made Word: Female Figures,
Women’s Bodies. Nightingale’s association of leisure and vice
recalls Charlotte Brontë’s account of “The Cleopatra” paint-
ing in Villette. Because scholars including myself have been
unable to date Nightingale’s note, I cannot determine if
Nightingale would have read Villette by this time.
18. For an account of how performances such as Greenwood’s
impersonation of what he labeled an “amateur casual” con-
fused prevailing notions of what amateurism and profession-
alism were in the Victorian period, see Koven, 38.
19. For more on Nightingale’s unwillingness to give her name to
causes to which she did not give her work, see her correspon-
dence with J. S. Mill reprinted in CW 5: 396, which I discuss
at greater length in chapter 3.
20. McDonald dates the essay [after May 12, 1871]. She reprints
the entire text of the essay CW 5: 281–90.
21. Seth Koven has documented this trend in his terrific book.
See Koven, chapter 1.
22. CW 1: 62; Nightingale on Quetelet MSS. 45842 ff. 197
23. Nightingale’s comment refers to Gladstone, Liberal Prime
Minister, 1868–1874, 1880–1885, 1886, and 1892–1894. She
also refers to Lord Overstone, Liberal Member of Parliament
for Hythe from 1819 to 1826. He was integral in work to-
ward the passage of the Bank Charter Act of 1844, and he
was president of Royal Statistical Society, 1851–53. Robert
Lowe was Chancellor of the Exchequer under Gladstone
(1868–1873) and Vice President of Education (1859–1864).
Though Nightingale shared views with each man, she would
have particularly objected to Lowe’s efforts to reverse the
steps James Kay Shuttleworth had taken to extend educa-
tion to the working classes (Goodlad, 6). Kay Shuttleworth
recorded his ideas about raising working class children out of
poverty through education in his report, Training of Pauper
Children (1839).
24. John Stuart Mill commented on this section of Nightingale’s
text: “Non mille fois non!! We hope, but we do not know
(CW 10: x).
Notes 163
25. In “In Memoriam, A. H. H.,” Tennyson represents Hallam

as a new, higher “type” of man, whose material self was more
greatly possessed of spirit than that of other human beings.
In the epilogue Tennyson writes,
Of those that, eye to eye, shall look
On knowledge, under whose command
Is Earth and Earth’s, and in their hand
Is Nature like an open book;
No longer half-akin to brute,
For all we thought and loved and did,
And hoped, and suffer’d, is but seed
Of what in them is flower and fruit;
Whereof the man, that with me trod
This planet, was a noble type
Appearing ere the times were ripe,
That friend of mine who lives in God,
That God, which ever lives and loves,
One God, one law, one element,
And one far-off divine event,
To which the whole creation moves.
26. CW 5: 132.
27. McDonald reprints Nightingale’s transcription of and anno-
tations to Agnes Jones’s journal from sometime following
Jones’s death from typhus on 19 February 1868.
28. See CW 6: 278–79.
29. In addition to the books McDonald cites in CW 5: 768,
McDonald also kindly shared with me other lists she com-
piled of books Nightingale read or donated. BL Mss 43402
f155 [List of books: among Harley St. Papers].
30. Letter to John McNeill. February 8, 1870. CW 5: 202–3.
31. For more on emigration in Dickens’s novels, see Grace
Moore, Dickens and Empire: Discourses of Class, Race, and
Colonization in the works of Charles Dickens.
32. Among these are Elizabeth Gaskell’s Mary Barton, Dickens’s
Hard Times, and others. For more on these, see Moore, 11.
33. I omit discussion of Woodcourt’s role as moral exemplar
here in the interests of focus and because excellent work in
this area has been done. See especially, Lauren Goodlad’s
164 Notes
discussion of Woodcourt as Dickens’s attempt to represent

effective Pastorship—a “doctor-as-hero”—in a nation oth-
erwise lacking in examples of moral, religious, and familial
guidance to address the problems of the poor and the lack of
community bonds between classes (Goodlad, 20).
34. “In Memoriam,” Add Mss 45842 ff142–99. February 21,
1874. Reprinted CW 5: 40–64.
35. In addition to Bede’s Charity, the novel of Stretton’s on
which this chapter primarily focuses, several of Stretton’s
works contain some version of extended or affiliative fami-
lies in the absence of parents. Little Meg’s Children features a
young girl who serves as mother to her two younger siblings
and who “adopts” as sister a fallen woman known as “Kitty,”
who is a tenant in their building. Meg’s good work leads to
the reunion of “Kitty” with her parents. Nightingale men-
tions Little Meg’s Children in a diary note from February 17,
1877 (CW 2: 441). In Brought Home, neighbor and town
saddler Ann Holland’s intervention saves a rector’s fam-
ily which was nearly broken by the wife’s alcoholism; Ann
accompanies them as part of their family when they emi-
grate to New Zealand in their effort to begin anew. Once
there she helps the wife achieve sobriety and nurses the
rector back to health after a severe illness. On their happy
return to England, she moves out of her saddlery and into
the rectory with her new “family.” Nightingale comments
on Brought Home in BL Mss 43402 f421. In Jessica’s First
Prayer, a coffee-stall keeper, David, gives breakfast once a
week to a young girl, Jessica, who is largely neglected by her
alcoholic mother. Jessica and David, with the help of a min-
ister and his family eventually find God and become a kind
of “family” themselves with the keeper providing daily meals
for Jessica. In Alone in London, “Old Oliver,” who owns a
News Agent shop takes in two waifs: one, a girl left at his
door named Dolly, and the other a young boy, Tony, who
(we learn at the novel’s beginning) shows up each morning
to help Oliver set up his shop; eventually, Tony sleeps in a
nook under the store counter. When Dolly turns out to be
the daughter of Oliver’s “fallen” runaway daughter, “Old
Oliver” has already functioned as parent to both children.
Additionally, Nightingale mentions Pilgrim Street: A Story
of Manchester Life in a diary note from the week of March 3,
Notes 165
1877 (CW 2: 446); Jessica’s Mother in a diary note from the

week of August 12, 1877 (CW 2: 464); Fern’s Hollow in a
diary note from the week of August 19, 1877 (CW 2: 467);
and The Fishers of Derby Haven in a diary note from the week
of September 2, 1877 (CW 2: 470). Nightingale gave Pilgrim
Street: A Story of Manchester Life, Enoch Roden’s Training,
Jessica’s First Prayer, and David Lloyd’s Last Will to nurses
(See CW 4: 526–27). Another novel Nightingale does not
mention, The Doctor’s Dilemma, features a young woman,
Olivia, who escapes literal incarceration at the hands of her
husband, to hide out on the remote island Sark. There the
sea captain, Carey, and his sister serve as adoptive family for
Olivia until events turn in her favor in the third volume of
the novel. It is notable that, of the novels listed here, this is
the only one that Nightingale appears never to have men-
tioned or donated to nurses, soldiers, or her various char-
ities. Either she didn’t know of it, which is unlikely given
Nightingale’s admiration for Stretton’s works. Or perhaps
the absence of any reference to it reflects the fact that the
novel contains a somewhat favorable representation of a fever
hospital in its third volume. Given Nightingale’s negative
view of fever hospitals (see chapter 3), she may have avoided
reading it, and almost certainly wouldn’t have bought it for
nurses or soldiers.
36. Nightingale mentions Bede’s Charity in a diary note from the
week of October 27, 1877 accompanied by her comment. “It
is never too late to mend” (CW 2: 479).
37. Unsigned note written on a letter. CW 3: 402.
3. Competing Visions: Nightingale,

Eliot, and Victorian Health Reform
1. Elizabeth Blackwell was the first woman M. D. and a friend
of Nightingale’s.
2. Dickens and Burdett-Coutts sent Nightingale a drying
machine while she was working in the Crimea.
3. Martineau also used Nightingale’s statistics to write England
and Her Soldiers. For more on this work see chapter 4.
4. The annotations appear on Jowett’s translation of Phaedrus,
275D-276A 277A.
166 Notes
5. The correspondence between Jowett and Nightingale is worth

quoting at length. After his letter asking Nightingale, “will
you please not let poor Middlemarch alone? She has gone
wrong, not only in the literary way, but I have a respect & re-
gard for her. And, moreover, she has more of the spirit which
you want to introduce into literature than any one else in the
present day. Let her be at peace. This is my request” (Jowett
256).
In his follow-up letter of January 25, 1874 he writes:
I see that you hate to be reproved, my dear lady, and I
am not going to reprove you any more. It is like pouring
cold water upon red hot iron, & makes a terrible hissing.
But you are mistaken if you suppose that I encourage
G. Eliot. Have I not asked her to my house, & gone to
see her, with the view of urging her to work at higher
things [such as moral philosophy], which she appears
willing to do. She talks of writing a moral Philosophy, &
told a friend of mine that she would like to write some-
thing special for women, but she felt that there were cer-
tain parts of her life which disqualified her. Only I think
that . . . you ought not to be so exasperated against her,
for she has many troubles & is the only woman in this
generation who can do much besides yourself . . . (Jowett,
256–57).
6. McDonald’s edition helpfully identifies Cluricaune as a lep-
rechaun. Octavia Hill was “an unmarried social reformer of
prestigious accomplishments,” particularly advocating for the
development of social housing and the availability of open
spaces for the urban poor (CW 5: 586n).
7. It may not be too much to say that Eliot’s depiction of the
tyrannical invalid, Peter Featherstone, trying desperately
to “do as he likes” in his final scenes may well have both-
ered Nightingale; Nightingale was a bit like Featherstone in
attempting to run things from her sickbed and perhaps (un-
derstandably) taking advantage of her invalidism, too, in
order to avoid the polite, social duties that would otherwise
have fallen to her as a Lady. Catherine Judd suggests that the
characters of Dorothea, Celia, and their uncle may have been
based on Nightingale, her sister Parthenope, and their father.
Of course, any resemblance Nightingale saw between herself
and Dorothea would have troubled her.
Notes 167
8. The evidence of that research is contained in the numerous

references throughout Middlemarch to important people and
discoveries in medical history. The record of that research is
evident in Eliot’s numerous writing journals including the
“Quarry for Middlemarch” published in the Norton 2nd
ed. of Middlemarch, ed. Bert Hornback and the Journals of
George Eliot, ed. Margaret Harris and Judith Johnston.
9. See Pugh and CW 5: 372 n.6.
10. George Eliot to Sara Hennell, January 18, 1856; Letters of
George Eliot 2: 225–26.
11. George Eliot to S. Hennell January 28, 1856. Letters of
George Eliot 2: 336.
12. See Bonj Szczygiel and Robert Hewitt, “Nineteenth-
Century Medical Landscapes: John H. Rauch, Frederick Law
Olmstead, and the Search for Salubrity.” Bulletin of the History
of Medicine 74.4 (Winter 2000): 708–734, p. 730 esp.
13. The Pastor Oberlin was a philanthropist, much like Octavia
Butler, interested in bettering the material and spiritual lives
of the poor. “He began by constructing roads through the
valley and erecting bridges, inciting the peasantry to the enter-
prise by his personal example. He introduced an improved
system of agriculture. Substantial cottages were erected, and
various industrial arts were introduced. He founded an itin-
erant library, originated infant schools, and established an
ordinary school at each of the five villages in the parish. In
the work of education he received great assistance from his
housekeeper, Louisa Scheppler (1763–1837)” (Encyclopedia
Britannica 11th ed.).
14. For more on the differences between French clinical medi-
cine at the Paris school and British medicine of the 1820s,
see Caldwell.
15. Hutchinson’s device was supposed to show how breathing
changed during times of normal growth versus times of dis-
ease. It measured what Hutchinson called the “vital capacity”
of the lungs. The patient breathed through a tube connected
to a receiver that was elevated by each increment of expired air;
then the amount of air expired was measured with the help
of a graduated scale, also invented by Hutchinson, called the
“vital capacity index” (Reiser, 92–93). As Reiser describes it,
the benefits of the device were not just its purported ability to
detect lung disease faster than any other currently acceptable
168 Notes
method (i.e., auscultation or percussion), but that doctors

could then determine who was or was not fit for armed ser-
vice work and other public duties (93). His claim that his
device not only provided a method of measuring breathing
against a standard measure, but also had the potential to par-
ticipate in the effort to quantify the social value of individu-
als seemed to offer extremely useful information to many in
competitive trades. In an article written two years earlier for
the Quarterly Journal of the Statistical Society of London enti-
tled “Contributions to Vital Statistics, Obtained by Means of
a Pneumatic Apparatus for Valuing the Respiratory Powers
with Relation to Health,” Hutchinson pitches his spirom-
eter as “a new method of determining the effect of trades
upon health, by ascertaining the presence of disease, and the
extent of deterioration in the health of the living individual”
(193). In this article he presents the results of his measure-
ment of the capacity of the lungs of eleven hundred and fifty-
one individuals of different occupations. By lung capacity,
Hutchinson means the “quantity of air which an individual
can force out of his chest by the greatest voluntary expira-
tion, after the greatest voluntary inspiration” taken in cubic
inches (194).
16. As mentioned above, Louis is Lydgate’s much-admired
instructor in Paris.
17. Untitled Editorial, Lancet (June 11, 1859).
18. Though I do not have space to address it here, the dis-
agreement among medical historians, particularly Erwin
Ackernecht and Margaret Pelling, as to the extent of
Paris school and other medical researchers’ belief in anti-
contagionist disease theory is fascinating. I connect anti-
contagionism with statistics because of the prominence
of anti-contagionist views in statistical studies cited by
Chadwick. See his famous “Sanitary Report” and his report
of “The Health of Towns.”
19. The discoveries that confirmed germ theories to all but a
select few, including Nightingale, came about through the
microscopical researches of Koch and Pasteur on fermenta-
tion and putrefaction in the 1870s and 1880s. Middlemarch
appeared prior to the publication of these two studies,
though not before Lister’s important work on bacteriology
(1867).
Notes 169
20. According to Anne Hardy, despite Louis’s treatise proposing

a distinction between typhus and typhoid, hospitals did not
distinguish between the two diseases in England until the
1860s. See The Epidemic Streets.
21. For a fuller account than I will provide in the pages that fol-
low of eighteenth-century medicine and the dramatic shift
from nosological to clinical medicine, see Michel Foucault,
The Birth of the Clinic and Reiser.
22. For an account of the enormous influence of Broussais and
Louis on American medicine and, more generally, on medi-
cal students at the Paris school, see Cassedy, 58–65.
23. For an extensive account of Broussais’s debt to the ideas
of Bichat and others, see the chapter “Crisis in Fevers” in
Foucault, The Birth of the Clinic, 184–85.
24. See Gregory, 19. I have commented more fully on the rela-
tionship between Hume and Gregory in “Medicine in the
1820s” (2004). In A Short History of Medical Ethics Albert
Jonsen claims that Gregory’s ethical views are, in fact,
adapted from Hume’s ideas about sympathy. According to
Jonsen, Hume held that “the entire moral life is founded on
a natural and intuitive sympathy with the moral sentiments
of others” (60). For a more detailed account of Hume’s
influence on John Gregory, see Laurence B. McCullough,
“Hume’s Influence on John Gregory and the History of
Medical Ethics.”
25. Drawing on Eliot’s translation of Feurbach’s Essence of
Christianity, Elizabeth Deeds Ermarth claims in “George
Eliot’s Conception of Sympathy” that for Eliot, “sympathy
depends on a division in the psyche, a split in consciousness
that permits two conflicting views to exist simultaneously.
This mental division is the material of conscience” (23). On
the fear of a new culture freed from strictures of sympathy,
see Welsh, 216–58.
4. Engaging the Victorian Reading

Public: Nightingale and the
Madras Famine of 1876
1. The letter was published in the Daily Telegraph, August 19,
1877 and the Times, August 20, 1877. CW 9: 768–69.
170 Notes
2. Reprinted in CW 9: 777–842.
3. On Nightingale’s and my use of the term “native,” see notes,
157, n. 6.
4. For more on the reforms themselves, see (among others)
Christopher Hamlin, The Science of Purity, and on fiction
and sanitary reform see Joseph. W. Childers and Pamela
Gilbert.
5. For a detailed historical discussion of this shift in Nightingale’s
focus, see Gourlay, Chapters 3–6 esp.
6. I follow Nightingale’s usage in referring to the British colo-
nial army in India as the Indian army. Indian native soldiers
within that army were called Sepoys. I intend to distinguish
British-born soldiers from Indian-born soldiers by using the
adjective “native” when referring to the latter. see 157, n. 6.
7. Those who read widely in Nightingale’s unpublished and
published writings will find that the attitude expressed here
is much less sympathetic than the attitude toward natives
that appears in much of her private correspondence of the
same period.
8. After all Martineau had just two years before translated, an-
alyzed, and condensed Auguste Comte’s Cours de Philosophie
Positif into English in 1854.
9. CW 9: 28.
10. Nightingale based her article “A Water Arrival in India” on
the Report #177 of Mr. Buckland, Commissioner of Burdwan
Division to Bengal Division. Burdwan January 23, 1874.
CW 9: 771.
11. CW 9: 784.
12. Gourlay, 10, 109, 139–47.
13. According to Gourlay, these enlightened views developed in
Bengal partly because of such education and partly because of
the influence of people like Ram Muhan Roy, Iswarchandra
Vidyasagar, and Henry Louis Derozio. Gourlay 92–93.
14. Gourlay, 92–95.
15. Nightingale repeated the same words almost verbatim in a
letter to the Liberal MP John Bright, who had just given
a speech in Manchester on the necessity of water to pre-
vent future famines. His speech was printed in The Times of
September 14, 1877, the same date of Nightingale’s letter to
Chadwick.
Notes 171
16. I find no evidence that Nightingale read women travelers’

narratives, though in the early 1880s she admired the work of
Emily Eden’s nephew, Ashley Eden, who, as lieutenant gov-
ernor to Bengal, addressed land tenancy issues in the Ryots’
interests (CW 10: 593–94)
17. Emily Eden, Up the Country: Letters written to Her Sister
from the Upper Provinces of India (1866) and Letters from
India, ed. by Her Niece, the Hon. Eleanor Eden (1866).
Fanny Parks, Wanderings of a Pilgrim in Search of the
Picturesque, during Four and Twenty Years in the East; with
Revelations of Life in the Zenana (1850), excerpts reprinted
in Ghose, Nineteenth-Century Travels Explorations, and
Empires.
18. See Mrs. G. Harris, A Lady’s Diary of the Siege of Lucknow,
Written for the Perusal of Friends at Home (1858); R. M.
Coopland, A Lady’s Escape from Gwalior and Life in the Fort
of Agra during the Mutinies of 1857 (1859), excerpts reprinted
in Ghose, Nineteenth-Century Travels Explorations, and
Empires. See also Augusta Beecher, Personal Reminiscences
in India and Europe, 1830–1888, of Augusta Beecher (esp.
127–75). Where attention is given to native Indians, it tends
to be utterly dismissive accounts of their collective savage
appearance, with no individualizing detail. See Mrs. Leopold
Paget, for example, Camp and Cantonment: A Journal of Life
in India, 1857–1859 with Some Account of the Way Thither
(esp. 76–77). One of the best resources for Victorian women
travelers’ accounts of life in India remains Indira Ghose’s
edited collection, Memsahibs Abroad: Writings by Women
Travelers in Nineteenth-Century India.
19. For an excellent concise, biographical sketch of Lawrence see
McDonald CW 9: 985–86.
20. The trading of slaves was abolished in England’s colonies in
1807, but current slaves were not freed by law until the 1833
act. Even after the act was passed, the law was not enforced
immediately.
21. Apparently the only Condition of England novelist (of
those about whom Nightingale comments) whose works
she didn’t particularly admire was Disraeli, whom she refers
to as “Dizzy” (McDonald 5: 335). Sibyl was the only novel
of his that Nightingale appears to have liked (McDonald 5:
172 Notes
772–73). For more on Nightingale’s literary tastes, see my

Introduction and McDonald 5: 725–808.
22. Mike Davis’s wonderful account of the political causes of
the Madras Famine in Late Victorian Holocausts: El Nino
Famines and the Making of the Third World includes dramatic
photographs of starving Indian natives taken by missionaries
as well as drawings of the same taken from William Digby’s
“Prosperous” British India: A Revelation from Official
Records and The Famine Campaign in Southern India: 1876–
1878. Digby’s reporting was entirely critical of the British
role in producing famine in India. Whether Nightingale got
the photographs she mentions from Digby and elsewhere is
unclear. But the existence of the missionaries’ photographs
that Davis reprints suggests it is possible that Nightingale
expected her readership may well have seen photographs like
these.
23. Nightingale and others claimed that the New Poor Law had
produced more paupers—those who took government assis-
tance. For more on her argument, see chapter 2.
24. See Childers.
25. According to McDonald, this is a reference to the dying she-
wolf who nurses Romulus in Thomas Babington Macaulay’s
“The Prophecy of Capys” in The Lays of Ancient Rome
(McDonald 9: 792 n. 44).
26. A letter from Sir Louis Mallet of the India Office informed
Nightingale that his colleagues had referred to her essay as
a “Shriek,” though he felt it “was a better expression of the
truth than any other utterance” (quoted in Cook, 2:292n;
McDonald 9: 778).
Epilogue: Nightingale in the

Twenty-first Century: The
Legend versus the Life
1. For an excellent account of twentieth- and twenty-first cen-
tury representations of Nightingale in literature and film, see
Bostridge, 525–646 esp.
2. Bostridge himself reminds us how many current issues
involving healthcare (“the shameful neglect of British troops
in Afghanistan and Iraq by the government at home,”
Notes 173
“worldwide rates in maternal mortality, hospital hygiene”)

Nightingale’s focus would have helped bring to the govern-
ment and public’s attention (546).
3. David Arnold, for instance, claims that Nightingale’s influence
on health improvements and policy in India was less important
than her proponents have wanted to claim. He believes that
historians’ focus on her contributions to efforts to improve
public health in India has obscured those of native Indians
engaged in the same struggle (Arnold, 71–72). No doubt he
is correct about the underappreciation of native Indians’ con-
tributions. For more on this issue see chapter 4.
4. Interestingly, Sibyl was the only novel of Disraeli’s that
Nightingale could stand (CW 5: 772). For more about
Nightingale’s views of Disraeli’s fiction, see Chapter 4, n.25.
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I n de x
Ackernecht, Erwin Bostridge, Mark, xiii, 4, 111,

“Anticontagionism 147–49, 159 n.11,
Between 1821 and 172 n.1, 172 n.2, 175,
1867,” 168 n.18, 175 180–81
Medicine at the Paris Brontë, Charlotte, 134,
Hospital: 1794–1848, 92, 162 n.17, 175
101–102, 175 Villette, 162 n.17, 175
affiliative family, 40, 69–71, Broussais, Francois, 99–103,
160 n.6, 164 n.35, 176 169 n.22, 169 n.23
Anderson, Amanda, xi–xii, Burdett-Coutts, Angela, x, 41,
xiv, 156 n.6, 156 n.7, 68, 75, 165 n.2
156 n.3, 175 Burnes, Alexander, 131–32
Anonymous “A Reverie Burton, Sir Richard, 131–32
after Reading Miss Buzard, James, 156 n.7, 175
Nightingale’s Notes
on Nursing,” 39, Caldwell, Janis, xiii,
160 n.4, 175 167 n.14, 175
Anonymous “Miss Florence Carlyle, Thomas, 156, 176
Nightingale,” 38–39, Carpenter, Mary, 65, 128
160 n.3, 175 Cassedy, James H.,
anticontagionism, 4, 9, 13, 169 n.22, 176
17, 19–20, 34–35, Chadwick, Edwin, xiv, 9–11,
98–99, 102, 158 n.9, 28, 58, 96–97, 115,
168 n.18, 175 122, 125, 129, 135, 149,
Arnold, David, 173 n.3, 175 159 n.13, 170 n.14,
Atkins, J. B., 110–11, 175 176, 178
“Address to the Metropolitan
Beale, Lionel, 96–97, 175 Sewage Manure
Beecher, Augusta, 171 n.16, 175 Company” (1846), 176
Beer, Gillian, 83, 175 The Health of Towns: Report
Bengal Social Science of the Speeches of Edwin
Association (BSSA), 128 Chadwick, esq., Dr.
Bichat, Xavier, 93, 101, Southwood Smith, and
169 n.23 Others (1847), 137
186 Index
Chadwick, Edwin—Continued Cook, Sir Edward, 86,

Report on the Sanitary 172 n.25, 176
Conditions of the Coopland, R. M., 171 n.16, 176
Labouring Population of Cotton, Arthur, 123–25, 176
Great Britain (1842), Crimea, x–xii, xv, 3–4, 7, 23,
10–11 25, 32, 37–38, 40,
Chalmers, Thomas, xiv, 58, 61, 42, 44–45, 47, 51–53,
157 n.2 56, 75, 80, 87, 106,
Childers, Joseph W., xiii, 140, 110–12, 115, 121, 133,
170 n.3, 172 n.23, 176 147, 155 n.3, 159 n.15,
Chisholm, Caroline, x, 65, 161 n.14, 165 n.2, 180
67–68 Cullen, Michael J., 176
cholera, xiv–xvii, 9, 21–23, 25,
32, 34–35, 94, 98, 102, Daston, Lorraine, xiii
156 n.11, 159 n.16, “The Moral Economy of
181–82 Science,” 176
Clavan, Sylvia and Ethel Vater, “Objectivity and the Escape
160 n.6, 176 from Perspective,” 176
Collins, Wilkie, xii, xiii, 4, 13, Daston, Lorraine, and Peter
24–25, 27, 176, 183 Galison, 177
The Woman in White, 4, 13, Davis, Mike, 172 n.22, 177
24–25, 27, 176 Dickens, Charles, x, xii–xiv, 3,
Comte, Auguste, xiv, 101–102, 5–6, 27–28, 37, 40–41,
120, 170 n.7, 176 45, 48, 65–71, 113, 115,
Cours de Philosophie Positif, 130, 134, 150, 156 n.5,
170 n.7, 176 163 nn.31–33, 165 n.2
“Examination of Broussais’s Bleak House, x, 45–46,
Treatise on Irritation,” 65–70, 73, 160 n.6, 177
101–102, 176 David Copperfield, 65,
Condition of England novel, 68, 177
xi, 68, 112–13, 130, Dombey and Son, 28, 65, 177
133–36, 139–41, Hard Times, 68,
151–52, 171 n.20 163 n.32, 177
contagion, 2, 4, 9–10, 11, 13, Little Dorrit, 65, 177
17–21, 27–28, 30–35, Oliver Twist, 3, 6, 65,
98–99, 102–103, 70, 177
156 n.12,159 n.13 Sketches by Boz, 3, 6, 177
moral contagion, 9–10, Digby, William, 172 n.22, 177
17–19, 27–28, Disraeli, Benjamin, 152,
159 n.13 171 n.20, 173 n.4, 177
contamination, 9–10, 19–21 Dossey, Barbara, xiii, 177
Index 187
Eastlake, Lady Elizabeth, 46, 66 Ermarth, Elizabeth Deeds, 105,

Eden, Emily, 131, 170 n.15, 169 n.25, 177
171 n.17, 177 Eyler, John M., 158 n.8,
Letters from India (1866), 159 n.10, 178
170 n.15, 177
Up the Country: Letters writ- famine, ix–x, xiii, 6, 37, 41,
ten to her Sister from the 52, 109–115, 121–30,
Upper Provinces of India 133–146, 152, 170 n.14,
(1866), 170 n.15, 177 172 n.22, 176–77
Eliot, George, x–xiv, 5–6, Farr, William, 23, 33, 159 n.10,
40, 48, 75–107, 149, 178
153, 158 n.5, 160 n.5, Feurbach, Ludwig, 169 n.25
161 n.15, 166 n.5, fever hospital, 79, 88–89, 91,
166 n.7, 167 n.8, 104, 165 n.35
167 n.10, 167 n.11, Freedgood, Elaine, xii, xiv,
169 n.25, 175, 177, 183 9–11, 29, 158 n.1, 178
Journals of George Eliot,
167 n.8, 177 Gaskell, Elizabeth, xii–xvii,
Letters of George Eliot, 82, 1, 3, 6–7, 58, 75, 113,
167 n.10, 167 n.11 115, 130, 134–43, 146,
Middlemarch, xiii, 5–6, 40, 149, 156 n.13, 156 n.14,
48, 76–107, 153, 157 n.4, 157 n.3, 163 n.32, 178,
158 n.5, 161 n.15, 183
166 n.5, 167 n.8, The Letters of Mrs. Gaskell,
168 n.19, 177, 183 156 n.14, 178
“The Quarry for Mary Barton: A Tale of
‘Middlemarch’,” Manchester Life [1848],
167 n.8, 177 6, 134–37, 139–43, 146,
Romola, 5 163, 178
Elliott, Dorice Williams, Ruth, 178
45–46, 177 Gates, Melinda, 155 n.2
emigration, x, 65, 67–68, 71, germ theory, 2, 9, 12, 21,
142, 163 n.31, 164 n.35 31, 34–35, 99, 104,
empiricism, 2, 10, 12–13, 16, 18, 159 n.16, 168 n.18, 180
23, 26, 28–35, 38, 59, Ghose, Indira, 131–33,
62, 80, 93, 98, 121, 176 170 n.15, 171 n.16,
epidemic disease, xiv, 9, 12–13, 176–78, 181
17, 21–22, 26, 55, 102, Ed and Intro. Nineteenth-
113, 134, 168, 175, Century Travels
178, 182 Explorations, and
see also, zymotic disease Empires: Writings from
188 Index
Ghose, Indira—Continued Herbert, Sidney, 22–23, 32

the Era of Imperial Hill, Octavia, 65, 77–79,
Consolidation, 1835– 166 n.6
1910. Vol. 3: India, hospital design, 43, 75
131–33, 170 n.15, Hume, David, 17–18, 105,
171 n.16, 176–78, 181 158 n.6, 169 n.24,
Memsahibs Abroad: Writings 179–80
by Women Travelers in Hunt, William Holman,
Nineteenth-Century 159 n.2
India, 131–33, Hutchinson, Jonathan, 94–95,
171 n.16, 178 167–68 n.15, 179
Gilbert, Pamela K., 21–22, Huxley, Thomas Henry, 179
170 n.3, 178
Gill, Gillian, xiii, 161 n.14, 175 imperialism, xii, 9, 114,
Goodlad, Lauren M. E., xiii, 118–19, 178
57–58, 157, 162–64, 178 India, x, xiii–xiv, xx, 2, 4, 6–7,
Gore, Al, xiv 13, 23, 34–35, 37, 40,
Gourlay, Jharna, xiii, 112, 128, 52–53, 65, 73, 78, 82,
148, 170 n.4, 170 n.11, 84, 109–52, 159 n.16,
170 n.12, 170 n.13, 178 160 n.1, 170 n.5,
Greenwood, James, 50–51, 54, 170 n.8, 170 n.15,
162 n.18 171 n.16, 172 n.22,
Gregory, John, 105, 169 n.24, 172 n.25, 173 n.3
178, 180 industrialism, xii, 9, 13,
77, 113, 134, 136,
Hamlin, Christopher, 23, 141, 167
170 n.3, 178 infection, xv, 18–21, 24, 26,
“Edwin Chadwick, ‘Mutton 30–32, 35, 51, 99,
Medicine,’ and the Fever 156 n.12, 158 n.9, 178
Question,” 178 invalidism, xvi, 25, 32, 40, 84,
A Science of Impurity: 166 n.7
Water Analysis in irrigation, 6, 112, 116,
Nineteenth-Century 120–27, 129
Britain, 23, 170 n.3, 178
Hardy, Anne, 169 n.20, 178 Jameson, Anna, 47–49,
Harley Street, xvi, 3, 119 161 n.14, 179
Harris, Mrs. G., 171 n.16, 178 Jolie, Angelina, ix, 155 n.2
Hegel, Georg Wilhelm Jones, Agnes, 62–64, 163 n.27
Friedrich, 56 Jonsen, Albert, 169 n.24, 179
Hepburn, Audrey, ix Jowett, Benjamin, 14–16,
Herbert, Christopher, 179 78, 82–83, 106, 149,
Index 189
158 n.4, 165 n.4, “The Lunacy Question:

166 n.5, 179, 181 Lord Shaftsbury’s
Dear Miss Nightingale: a Evidence,” 179
Selection of Benjamin
Jowett’s Letters to Maclean, W. C., 35, 160 n.17, 179
Florence Nightingale, Madonna, ix
1860–1893, 82, 106, Madras, 109–11, 115, 121–24,
166 n.5, 179 126, 135, 140, 144,
Introduction to and 172 n.22, 176
translation of Plato’s Manchester, 134, 136, 164–65,
Dialogues, 14–16, 78, 170 n.14, 178–80
158 n.4, 165 n.4, Marsh, Jan, 148, 180
179, 181 Martineau, Harriet, 3, 75,
Judd, Catherine, xii, xiv, 40, 82, 113, 120–22, 149,
76, 156 n.9, 156 n.15, 170 n.7, 180
157 n.4, 158 n.5, British Rule in India,
160 n.5, 166 n.7, 179 120–22, 180
England and Her Soldiers,
Kay, James Phillip, xiv, 28, 96, 75, 165 n.3, 180
159 n.13, 162 n.23, 179 McCullough, Laurence,
Kay-Shuttleworth, James Phillip, 169 n.24, 178, 180
xiv, 162 n.23, 179 McDonald, Lynn, xiii–xiv,
Kidman, Nicole, ix xx, 7, 34–35, 64, 148,
Kingsley, Charles, 27, 179 159 n.16, 161 n.8,
Koch, Robert, 34–35, 162 n.20, 163 n.27,
159 n.16, 168 n.19 163 n.28, 163 n.29,
Koven, Seth, 42, 50–51, 54, 166 n.6, 171 n.18,
161 n.9, 162 n.18, 171 n.20, 172 n.24,
162 n.21, 179 172 n. 25, 180–81
“Florence Nightingale
Laennec, Rene, 91 and Germ Theory, its
Lawrence, Sir John, 114, 119, Practice and Politics”
132, 149, 171 n.18 Unpublished Ms.,
Levine, George, xiv, 179 34–35, 159 n.16, 180
Lister, Joseph, 168 n.19 Florence Nightingale Project,
Logan, Peter Melville, 179 xx, 7
Long, Reverend James, 128 McNeil, James, 56, 67,
Loudon, John Claudius, 88 159 n.15, 163 n.30, 180
Louis, Pierre, 91–92, 95, McNeil, James, and Alexander
99–103, 168 n.16, Tulloch, “Report of
169 n.20, 169 n.22 the Royal Commission
190 Index
into the Supplies of the Works

British Army in the “ABCs of Workhouse
Crimea,” 159 n.15, 180 Reform,” 62
Messinger, Gary, 180 Annotations to Benjamin
Metz, Nancy Aycock, Jowett’s introduction
158 n.3, 180 and translations of
Michie, Helena, xix, 156 n.8, Plato’s A Contribution
160 n.5, 162 n.17, 180 to the Sanitary History of
The Flesh Made Word: Female the British Army During
Figures, Women’s Bodies, the Late War with Russia
162 n.17, 180 (1859), 180
Sororophobia: Differences Dialogues, 14–16, 78,
among Women in 158 n.4, 165 n.4, 181
Literature and Culture, “How People May Live
156 n.8, 160 n.5, 180 and Not Die in India”
microscopy, xv, 79–82, (1863), 118–19, 128
92–93, 96–99, 104, Introductory Notes on
168 n.19, 175 Lying-In Institutions
Middlesex hospital, xv, xvii (1871), 160 n.1
Mill, Harriet Taylor, 81–82 Letter: Lancet, 2 (Nov. 19,
Mill, John Stuart, xiv, 54, 1870), 35, 160 n.17, 181
56, 65, 81–84, 149, Letter to the Lord Mayor
162 n.19, 162 n.24 (1877), 109, 129
Miller, D. A., 180 “A Note of Interrogation”
Moore, Grace, 163 n.31, (1873), 160 n.1
163 n.32, 180 “A Note on Pauperism”
Muller, George, 58, 61 (March 1869), 60–61
Notes on Hospitals, 3rd ed.
natural history, 27, 179 (1860), 4–5, 10–21,
New Poor Law, x, xiv, 2–6, 30–34, 37, 42–45,
37, 40–45, 50, 52–53, 158 n.9, 160 n.2,
55–58, 61–62, 70, 161 n.10, 181–82
82, 84, 119, 131, “Notes on Nursing for
137, 139, 155 n.5, the Labouring Classes”
157 n.2, 160 n.1, (1861), xi, 158 n.7, 181
172 n.22, 179 Notes on Nursing: What it is
Nightingale, Florence, concept and What it is Not (1860),
of “law,” 1–2, 17–18, 28, xi, 4–5, 10–20, 23–30,
55, 58–60, 62, 70 33–34, 37–39, 42–45,
reputation as “Lady of the 81, 160 n.2, 160 n.4,
Lamp,” xii, 2, 45 161 n.10, 175, 181–82
Index 191
Notes on the Supposed 103, 112, 115, 119,

Protection Afforded 147, 155 n.3, 157 n.4,
against Venereal 158 n.5, 158 n.7,
Disease by Recognizing 159 n.16, 160 n.2,
Prostitution and 160 n.4, 160 n.5,
Putting it under Public 161 n.10, 161 n.14,
Regulation (1863), 164 n.35, 172 n.24,
160 n.1 175, 179, 181–82
“Observations by Miss
Nightingale on the Oberlin, Pastor, 167 n.13
Evidence Contained Owen, David, 88, 181
in Stational Returns”
(1864), 115–18, 122 Paget, Mrs. Leopold,
“The People of India” 171 n.16, 181
(1878), 109–10, 114, Parks, Fanny, 131, 170 n.15, 181
127–30, 133–35, “participant observer,” xii,
143–44, 152 xv–xi, 3, 7, 156 n.7,
“Politics and Public 157 n.3
Administration” (unpub- Pasteur, Louis, 168 n.19
lished essay), 53–55 pauperism, 16, 54–57, 60–63,
“A Proposal for Improved 65, 67, 70, 77, 139–40,
Statistics of Surgical 162 n.23, 172 n.22, 179
Operations” (1863), pauper nurses, 54, 57, 60,
160 n.1 62–63
“A Subnote of Pelling, Margaret, 21,
Interrogation” (1873), 168 n.18, 181
160 n.1 Penner, Louise, xxi, 181
Suggestions for Thought People’s Charter, 142
after Truth among the Permanent Settlement
Artizans of England (1793), 111
(1860), 56–57, 83–87, philanthropy, x, 2, 5, 38–45,
160 n.1, 180 48, 59–60, 64–66,
“Una and the Lion,” 138, 155 n.2, 157 n.2,
63–64 161 n.7, 177, 181, 183
“A Water Arrival in India” physician-patient
(1878), 114, 125–27, relationship, 105
170 n.8 Pinel, Phillipe, 101
nursing, x–xi, xiii, xvi–xvii, 1–5, Plato, 2, 14, 16, 60, 78, 179, 181
10–20, 23–30, 33–34, Poor Law of 1601, 155 n.5
37–47, 54, 57, 62–67, Poor Law Amendment Act of
75, 80–81, 85–86, 1834, see New Poor Law
192 Index
Poovey, Mary, xii–xiii, 57–58, 1860), 37–39, 42–45,

155 n.3, 156 n.9, 160 n.2, 161 n.10, 182
157 n.2, 159 n.13, Rothfield, Laurence, xiii, 182
159 n.14, 181 Russell, William Howard, 4,
Making a Social Body, 110–11, 130, 133, 175
xiii, 57–58, 157 n.2, Ryot, 6–7, 110–16, 119–23,
159 n.13, 181 126–34, 138–46,
Uneven Developments, 151–52, 171 n.17
xii, 155 n.3, 156 n.9,
159 n.14, 181 sanitation, x, xiii–xiv, 2–6,
positivism, 2, 99–104, 120–21, 9–13, 16–26, 29–40, 43,
170, 176 52, 55, 58–59, 75–76,
poverty, see pauperism 79–89, 92, 95, 97–98,
Pre-Raphaelite brotherhood, 103–107, 112–30, 134,
26, 159 n.12 151, 157 n.2, 158 n.3,
Prochaska, F. K., 181 158 n.9, 159 n.15,
168 n.18, 170 n.3, 176,
Quain, Richard, 34, 180, 182
159 n.16, 181 Scutari, x, 1, 3, 32–33, 112,
quarantine, 22, 94, 98–99, 159 n.15
158 n.8, 182 Sen, P. K., 129, 149
Quetelet, Adolphe, xiv, 58–59, sensation novel, 4, 11–15,
149, 162 n.22 24–27, 42, 51, 54, 76,
158 n.3, 159 n.12,
realism, xi–xiv, 5–6, 10–14, 76, 182–83
151, 157 n.3, 183 Sepoy mutiny (1857), 6, 110, 120
Reiser, Stanley Joel, 95, Showalter, Elaine, 158 n.2,
167–68 n.15, 181 159 n.12, 182
Review of Between Two Thieves Simon, John, 22–23, 34, 182
by Richard Dehan. The Sleeman, William, 132–33
Athenaeum (July 27, “slumming,” 42, 50, 161 n.9,
1812), 150–51, 181 179
Review of Florence Nightingale: Small, Hugh, xiii, 31–34,
The Making of an Icon 159 n.15, 182
by Mark Bostridge. Smith, Barbarah Leigh, 82
The Atlantic (2009), Smith, F. B., xii, 182
148–49, 151, 181 Smith, Sarah, see Stretton,
Review of Notes on Nursing, Hesba
Notes on Hospitals, by Smith, Thomas Southwood,
Florence Nightingale, 20–21, 158 n.8, 176, 182
and Care of the Sick by Snow, John, xv, 21–23, 34,
Richard Barwell (July 156 n.11, 182
Index 193
Socrates, 14–15, 78 A Thorny Path, 73,

Sophists, 15–16, 60 164–65 n.35, 183
statistics, 1–2, 6, 9–13, 17, Struthers, Sally, ix, 155 n.2
22–24, 28, 30, 53–58, suffrage, 76, 83–84
62–64, 73, 75, 79–84, sympathy, ix–x, xiii, 2, 29,
92–98, 104, 112, 38–41, 44, 66, 77–87,
115, 119, 121, 123, 97, 103–107, 123–25,
129–30, 135–36, 145, 136, 141, 152, 155 n.3,
159 n.10, 160 n.1, 169 n.24, 169 n.25, 177
162 n.23, 165 n.3,
167–68 n.15, 168 n.18, Tambling, Jeremy, xiii, 183
176, 179 Taylor, Helen, 81–83
Stowe, Harriet, 64 Taylor, Jenny Bourne, 183
Strachey, Lytton, xii, 182 Tennyson, Alfred Lord, 56,
Stretton, Hesba [Sarah Smith], 163 n.25, 183
xii, xiv, 5, 37, 41, Thomson, Samuel John,
71–74 151–52, 183
Alone in London, typhoid, 9, 91–92, 99,
164–65 n.35, 182 102–103, 169 n.20
Bede’s Charity, 71–72, typhus, 63, 91–92, 99,
164–65 n.35, 102–103, 158 n.8,
165 n.36, 182 163 n.27, 169 n.20, 182
Brought Home,
164–65 n.35, 182 Uglow, Jenny, 183
David Lloyd’s Last Will, utilitarianism, 2
164–65 n.35, 182
The Doctor’s Dilemma, Villiers, Charles P., 62–63
164–65 n.35, 182
Enoch Roden’s Training, W. A. F., 150–51, 183
164–65 n.35, 182 Warhol, Robyn, 156 n.10, 183
Fern’s Hollow, war office, xiv, 3, 159 n.15
164–65 n.35, 182 Welsh, Alexander,
Fishers of Derby Haven, 169 n.25, 183
164–65 n.35, 182 Woodham-Smith, Cecil, 183
Jessica’s First Prayer, Wood, Summer, 155 n.2, 183
164–65 n.35, 182 Workhouse, x, xiv, 6, 37, 42,
Jessica’s Mother, 50–51, 54–57, 60–65,
164–65 n.35, 183 71, 75, 77, 82, 84, 119,
Little Meg’s Children, 131, 155–56 n.5
164–65 n.35, 183
Pilgrim Street, Zemindar, 111, 127, 144
164–65 n.35, 183 zymotic disease, 23

Medicina Victoriana y Reforma Social

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Vic t or i a n M e dic i n e a n d

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1. English prose literature—Great Britain—History and criticism.

International news and entertainment media chronicle the

of whose economic, social, and health problems they need

It would be a mistake, however, to confuse Nightingale’s

narrators of her essays and novels, models of ideal sympathetic

nursing and of social reforms backed by statistics-based sani-

and George Levine both trace the development of what they

the Nightingale family home, just prior to Nightingale’s de-

Miss Florence Nightingale, who went on the 31st of August to

Gaskell’s nearly breathless rehearsal of Nightingale’s vividly

Gaskell quickly moves from the subject of disease to her

Gaskell asks her friend to imagine an idealized portrait of

her services—to the Middlesex Hospital &c! I came in here for

Gaskell’s representation contains some of the reverence that

I owe enormous thanks to many colleagues, friends, and fam-

her keen editorial eye. To Farideh Koohi-Kamali for represent-

The idealistic, thirty-one-year-old Florence Nightingale

sanitation, Poor Law reform, and economic and health reforms

As we shall see in the chapters that follow, Nightingale

the direction of adopting sanitary science as a kind of moral

and Poor Law Reform in Nightingale, Dickens, and Stretton,”

impulses than marriage to an aspiring, idealist Middlemarch

herself as a sympathetic and knowledgeable, but also a humble

In Victorian Writing about Risk (2000), Elaine Freedgood

when referring to disease transmission explained as resulting

readers a heightened concern about sanitation and an increased

popular variant of the Victorian realist novel, which emerged

the statistical, anti-contagionist health reports of the 1840s

same year as Notes on Nursing and Nightingale’s third edition

Combining Fact and Fiction for

the argument with flashy, rather than substantive, rhetoric.

Nightingale’s annotations to this paragraph indicate her

will surely inspire readers to heroism. She writes in the margin,

Capturing the Reader’s Imagination:

that suggests her awareness of the importance of tailoring her

The idea of “contagion,” as explaining the spread of disease,

Leaving aside for a moment the ideological problems evident

His own laws expressly to relieve us of responsibility. (Notes on

The reference to the impossibility of God “break[ing] His

not use the essay explicitly as a platform from which to make

Of all the methods of keeping patients warm the very worst is

The logic of these claims may be evident to a twenty-first cen-

writes, “Old papered walls of years’ standing, dirty carpets,

between the contagion and environment positions by using

tool” (Gilbert, 62). It was, nevertheless, influential enough

The insult to Simon’s credibility as a scientist—the association

to illustrate a hypothesis, rather than the results of an ade-

Disease Rhetoric and Sensation

circulating within medical and reformist circles about disease

A short time ago a man walked into a back-kitchen in Queen

Of course, sensation fiction of the 1860s also often took its

It seems no accident that the novel also features a hypo-

efforts to observe all natural phenomena calmly and rationally,

I began to doubt whether my own faculties were not in danger

to come to no decision that plain fact did not warrant, and to

Hartright’s decision to work inductively from evidence that

Here, moral contagion appears in constant conjunction with

about women’s natural abilities to nurture, care, and sym-

But I think in no country are women to be found so deficient

be trusted . . . for want of a practiced and studied observation.

In claiming an ability to measure “capability,” which would