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Reviews / Comptes Rendus

Jharna Gourlay, Florence Nightingale and the Health of the Raj (Aldershot, England: Ashgate 2003)

WHEN GLADSTONE called, unannounced, on Florence Nightingale (1820-1910) in December 1884, she declined to see him. Such was still the stature of "the Lady with the Lamp" that she could decline to receive the Prime Minister without worrying that she had given offense or burned bridges to future access. As a member of a well connected family and a woman who had come to be internationally revered for her leadership in nursing and many other aspects of health care, Nightingale could safely assume that she would continue to have the ear of powerful figures just as she had had since the 1850s. As the title of her book indicates, Gourlay focuses exclusively on Nightingale's involvement with health issues in India. She probably overstates the degree of ignorance that exists about this aspect of Nightingale's career and previous authors' neglect of it. Most scholars with even a peripheral interest in Nightingale or in Victorian measures to "modernize" health care in India will probably be aware of her involvement there even if they are unfamiliar with the specific issues that engaged her. Lynn McDonald's well-known project, The Collected Works of Florence Nightingale, includes plans for two of the eventual sixteen volumes to be devoted to Nightingale's work for public health in India, the only topic, in addition to nursing, to merit two separate volumes. That said, neither specialized scholarly studies like Antoinette Burton's Burdens of History: British Feminists, Indian Women, and Imperial Culture, 1865–1915 nor popular works like Gillian Gill's lengthy new biography give more than passing reference to Nightingale's work for India. Gourlay, then, can rightly lay claim to having written a pioneering work.

The phrase "for India" rather than "in India" requires emphasis: like James Mill before her and Marie Stopes later, Nightingale sought to influence events on the Indian sub-continent without ever having been there. Indeed, in the case of Nightingale, it was work conducted from the confines of her bedroom, since, for most of her post-Crimea years, she was, in her own words, "an incurable invalid." (227) Nightingale's work was also conducted "for India" in another sense, Gourlay maintains. Though it began in the wake of the 1857 "Mutiny" with the imperialist goal of improving the health of British troops so that they could more effectively "hold" India, her purview gradually widened to include the well-being of all of India, and especially its peasant majority. The idea of an English gentlewoman who had never once visited India offering detailed blueprints for numerous reforms there must initially strike almost any modern reader as the height of imperial arrogance. Yet Gourlay argues that Nightingale did have well-informed and increasingly compassionate advice to offer in regard to public health matters. And the number of those who wrote or visited her to seek information and advice — they included middle-class Indian social reformers as well as private and public British figures from Gladstone on down — provides compelling evidence that her views were seen to matter. A succession of viceroys sought her out, among them two former governors-general of Canada, Lord Dufferin and Lord Lansdowne. Not that Nightingale necessarily waited to be sought out. Having requested and pored over government documents on India and digested endless statistics, she provided summaries and reports to those in a position to initiate action and lobbied élite members of the political and health reform communities in an effort to have them exert influence. Leaking advance information to sympathetic journalist/reformers such as Harriet Martineau and Edwin Chadwick, as she did to facilitate action on the 1863 report of the Royal Commission on the sanitary state of the British army in India, was but one of her tactics. Moreover, she had contrived to have the commission appointed and to determine its membership, and her Observations formed an important part of its report.

Gourlay deals with this first of Nightingale's India initiatives following an introductory chapter that provides a preview of her successive projects as well as her modes of work. Though the focus of the Royal Commission Report was on British troops in India, her Observations also dealt with the deplorable sanitary conditions of the sepoys and brooked no excuses for past inaction: "Talk about 'caste prejudices' was to her 'an excuse for European laziness.'"(37) Her work would increasingly widen out and increasingly focus on Indians, beginning with matters of rural sanitation. Though she initially attributed the unhealthy conditions in which Indian villagers lived to their "filthy and injurious habits," (102) she came to see the problem as one of government inaction and imperial officials' tendency to justify a lack of improvements on grounds of costs and Indians' "apathy." With this broader understanding, Gourlay maintains, Nightingale began to reach out to Indian reformers and to perceive the degree to which poverty was at the root of sanitary and social problems. This, in turn, led her to advocate such agricultural improvements as irrigation projects and reforms to the land tenancy system. The latter she regarded as having worsened for peasants under British rule as a result of changes introduced in the role and power of the zemindars (landholders) to facilitate production for export. Nightingale supported Lord Ripon, the most liberal of "her" viceroys, in his 1880s efforts to obtain a Bengal land tenancy bill that would improve the situation of the peasants. Likewise, she backed his ill-fated efforts to secure passage of the Ilbert Bill, whose initial version would have allowed Indian as well as European magistrates to try Europeans in criminal courts. It was as part of a strategy to support Ripon, Gourlay believes, that Nightingale declined to receive Gladstone, calculating that a carefully worded letter would accomplish more than an unanticipated meeting. In the last decade of her India work she returned to a focus on village sanitation, this time with an emphasis on self-help, especially through the agency of middle-class and village women. She also supported a new initiative, the Lady Dufferin Fund (formally known as the Association for Supplying Female Medical Aid to the Women of India), to provide professionally trained Western and Indian medical practitioners for zenana women. Having described the evolution of Nightingale's India interests, Gourlay in a final chapter assesses the practical outcomes of her subject's prodigious efforts. Cited as "tangible contributions ... that no one could quibble about" (254) are improvements in army sanitation and living standards, the keeping of systematic mortality statistics, and the introduction of modern nursing. Much more could have been accomplished, Gourlay believes, if imperial officials had followed up on Nightingale's recommendations.

Without wishing to demean this remarkable woman's commitment to a land she had never seen, one could wish that Gourlay had put Nightingale's work for India into a larger context and acknowledged more fully that many other actors, Western and Indian, played an equal, or larger, role in many of "her" causes. In regard, for instance, to the introduction of modern nursing and female doctors in India and the training there of indigenous practitioners, Gourlay both gives too much credit to Nightingale and exaggerates the impact of what was accomplished. Outside the Indian Christian community, nursing remained a despised occupation well into the 20th century. It is thus difficult to accept Gourlay's claim that its introduction "was a step forward in the fight for equal rights and opportunities for Indian women." (257) Nor did the Dufferin Fund owe as much to Nightingale or play as pioneering or successful a role in providing British and indigenous women doctors for India as Gourlay implies. (She appears unaware of the pioneering role of US women.) Indeed, the number of Indian women doctors was still small and their status still generally inferior in both Dufferin-Fund and mission-run facilities until late in the colonial era. Meanwhile, in regard to the wider, preventive aspects of public health work to which Gourlay devotes a substantial portion of her book, there were layers of complexity beyond "administrative incompetence and indifference" (260) to inhibit successful modernization in colonial India, as recent works by historians like David Arnold and Mark Harrison have shown. While works by these and other scholars are cited in support of her emphasis on this particular causal factor, there is scant evidence that she has been influenced by their recognition of the broader cultural limits on, and indeed the inherent limitations in, medical modernization for colonial India.

Gourlay's tendency to generalize, and to construct dichotomies while eschewing complexity, is also evident in regard to matters of gender. The assertion, for instance, that in Victorian England "Men were considered superior in every respect and women, rich or poor, had no scope for a proper education, professional opportunity or vocational training" (4) ignores the fact that many middle-class and élite women used informal channels for educating themselves and exercising influence, especially in matters of social reform. Nightingale herself is only the best-known example. Likewise, Nightingale's deployment of a discourse of self-effacement in writing to political élites (what she herself delightfully styled "importunate widowing" [30]) was, presumably, a disarming strategy, an effort to soften and disguise the exercise of her own power. Furthermore, it was a discourse that contrasted sharply with that used in 1860 to reject the new phenomenon of women doctors ("they have only succeeded in being third rate men" [226]) and that used in 1896 to voice reservations about suffrage ("I am afraid I have been too enraged by vociferous ladies lecturing upon things they knew nothing at all about" [227]). To be sure, Gourlay makes no claims for Nightingale as a feminist. But neither does she take advantage of her rich knowledge of Nightingale and her vast literary output to analyse her discursive strategies or consider the reasons for her lingering reservations about larger roles for Western women.

There is, finally, the matter of Nightingale's spirituality. Gourlay writes that her subject was "profoundly religious," (6) but she does not explore the ways that Nightingale's religious convictions might have inspired her work for India. Florence Nightingale and the Health of the Raj, is, in sum, a narrowly focused, somewhat reverential, work, one that would have been enriched by more attention to matters of context and more openness to recent scholarship on gender and colonialism. Nonetheless, there is much to be gained from Gourlay's close and respectful account of Nightingale's long-lasting commitment to India, including an awed appreciation for the dedication that kept her locked in her bedroom reading those government reports.


Ruth Compton Brouwer King's University College, University of Western Ontario

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