Florence Nightingale and the Health of the Raj (review)

There is a certain dread in reading any new work on Florence Nightingale. So much has been written to so little effect, often derivative and wallowing in preconceptions. Fortunately, this book dispels such foreboding. It is based on sound research, a respect for evidence, keen analysis, and expert knowledge of India. Its engaging style makes it highly suitable as a textbook, as well as for general and specialist reading.

Nightingale is most famous as the Lady of the Lamp, the heroine and founder of modern, lay nursing. Yet Jharna Gourlay points out that, on Nightingale's death, all but two of the seventy-one publications found in her home related to India. Gourlay tells a fascinating story of Florence Nightingale's dedication to India despite never having been there. She was the "Governess to the Governors" (51) from whom most viceroys met and accepted advice, dispensed mostly from her London bedroom. Furthermore, Nightingale was involved in India for some forty years, essentially from 1857–98. Gourlay provides succinct summaries of the complicated backgrounds to the phases she has identified in Nightingale's thinking. The first phase aimed to improve army sanitation and hence military mortality. Gourlay convincingly argues that, despite official obfuscation, this was a limited and achievable goal. Nightingale's later progress in identifying more fundamental problems, such as land tenure and women's education, meant that her goals became less achievable. Gourlay demonstrates how and why Nightingale lost faith in government action and increasingly turned to the Indian middle class to implement her ideas. The reader is introduced to an astounding range of reforms that Nightingale, this most polymath of Victorian women, advocated for India in the later years of her involvement.

Throughout the book, Gourlay provides evidence of Nightingale's modus operandi. In different contexts, she shows how Nightingale requested facts, lobbied powerful individuals, leaked information to the press, wrote myriads of letters, and published papers and monographs. What she underestimates is the extent to which Nightingale was part of a mutually cooperative network of liberal reformers. Not only did Nightingale write much that was not attributed to her, as Gourlay and others have pointed out, but others did the same for her. Gourlay's conventional gender analysis ignores the fact that, in Nightingale's case, those unacknowledged others were mostly men, such as her Crimean War comrade Dr John Sutherland. He appears to have drafted for Nightingale what Gourlay considers "one of her best letters" (99).

In her conclusion, Gourlay bravely tackles the central question about Nightingale's work for India: "what exactly did she do, apart from writing" (254)? When the focus is on the individual, it is hard to resist the temptation to exaggerate his or her contribution by converting correlation to causation: the death rate in the Indian army barracks declined steadily from the 1860s; therefore, it was due to Nightingale. Lady Dufferin's Fund improved medical services and supported female, trained nurses in a way approved by Nightingale; therefore, it was due to her. Gourlay attributes much to Nightingale, only occasionally drawing back, acknowledging that many others also advocated the same Indian reforms. The tension between a biographer wanting to chart a subject's impact and the difficulty of determining that impact results in a dilemma. That dilemma is intensified because, as Gourlay points out, Nightingale had no official position. In an age in which we are obsessed with quantification, the extent of Nightingale's contribution is frustratingly elusive. Gourlay underestimates a further factor that complicates the methodological issues: the impact of the extensive Nightingale papers. Gourlay's chapter on the fortuitously preserved correspondence of Nightingale to P. K. Sen, when there is virtually no reference to these letters in Nightingale's papers, illustrates the role of serendipity in our access to evidence. If others in Nightingale's circle had left similar archives, would similar books be possible about their impact on India? The saving grace of this book is that Gourlay's...