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Authors: Laurence Lerner
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before us looked so different now the bright spirit which had breathed through it, and given it such exceeding beauty, had flown to a region far more suited for it than this world of sin and sorrow.
Almost every detail tells us that the body, having released Chatty's spirit, no longer matters. Whatever she had died of, the description would have been much the same: all that needs to be said about the empty shell is that it has lost the bright spirit which breathed through it.
To say that something does not matter can, of course, be a defense mechanism: it might matter very much, and hence be a topic we would rather avoid. The great avoidance in nineteenth century linguistic practice, as everyone knows, was sex. Dismissing sex as a mere animal impulse, not worthy of serious attention and shameful to talk about, must have served several purposes: for instance, allowing men to indulge in it without too much fuss being made, allowing women not to talk about it and so, it is presumably hoped, not to have the discomfort of thinking about it. I do not find it easy to decide whether something similar is true of illnesswhether the malfunctioning of the body was regarded as an indelicate topic, and so repressed, enabling us to think of the human being as essentially spiritual.
And then there is a final possibility, the most interesting of all, though the hardest to pin down: a skepticism about diagnosis springing from skepticism about the classification of disease. To explain this, I turn to Florence Nightingale's Notes on Nursing, published in 1860.
This admirable book is packed with keen observation and sensible advice, revealing how carefully and sensitively Nightingale had thought about every detail in the sick room. It treats the patient as a frail but responsible person, suggesting, for instance, that his stomach, even if
Page 38
expressed as whims and fancies, may be a more reliable guide to diet than chemistry; and it explores what every aspect of nursing practice must look like to the person forand towhom it is done. Most striking, for our purpose, is the emphasis placed on hygiene. The health of a house depends on five essential points: pure air, pure water, effective drainage, cleanliness, and light. This, Nightingale claims, is what every schoolgirl should be taught (rather than "the coxcombries of education" such as the elements of astronomy) and what every nurse should concern herself with. The first rule of nursing is to "keep the air [the patient] breathes as pure as the external air, without chilling him," because foul air is the cause of disease not contagion but foul air:
Is it not a fact, that when scarlet fever, measles or smallpox appear among the children, the very first thought is "where" the child can have "caught" the disease. They never think of looking at home for the source of the mischief. If a neighbour's child is seized with smallpox, the first question which occurs is whether it has been vaccinated. No-one would undervalue vaccination; but it becomes of doubtful benefit to society when it leads people to look abroad for the source of evils which exist at home.
Florence Nightingale is here taking sides in an important medical controversy on the cause of disease, that between the believers in miasma and the believers in contagion. Miasma describes the state of the environment in general terms; contagion refers to something specific. The reason Nightingale resisted it so strongly is that it would introduce an element of pure chance into the battle between order and disorder:
The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of whitewashing; in one word, defective household hygiene. 22
These are the words of a moral crusader, and Charles Rosenberg has pointed out how central such moral fervour is to Nightingale's conception of nursing. 23 If we put our lives in order, we shall not catch scarlet fever or measles or
Almost every detail tells us that the body, having released Chatty's spirit, no longer matters. Whatever she had died of, the description would have been much the same: all that needs to be said about the empty shell is that it has lost the bright spirit which breathed through it.
To say that something does not matter can, of course, be a defense mechanism: it might matter very much, and hence be a topic we would rather avoid. The great avoidance in nineteenth century linguistic practice, as everyone knows, was sex. Dismissing sex as a mere animal impulse, not worthy of serious attention and shameful to talk about, must have served several purposes: for instance, allowing men to indulge in it without too much fuss being made, allowing women not to talk about it and so, it is presumably hoped, not to have the discomfort of thinking about it. I do not find it easy to decide whether something similar is true of illnesswhether the malfunctioning of the body was regarded as an indelicate topic, and so repressed, enabling us to think of the human being as essentially spiritual.
And then there is a final possibility, the most interesting of all, though the hardest to pin down: a skepticism about diagnosis springing from skepticism about the classification of disease. To explain this, I turn to Florence Nightingale's Notes on Nursing, published in 1860.
This admirable book is packed with keen observation and sensible advice, revealing how carefully and sensitively Nightingale had thought about every detail in the sick room. It treats the patient as a frail but responsible person, suggesting, for instance, that his stomach, even if
Page 38
expressed as whims and fancies, may be a more reliable guide to diet than chemistry; and it explores what every aspect of nursing practice must look like to the person forand towhom it is done. Most striking, for our purpose, is the emphasis placed on hygiene. The health of a house depends on five essential points: pure air, pure water, effective drainage, cleanliness, and light. This, Nightingale claims, is what every schoolgirl should be taught (rather than "the coxcombries of education" such as the elements of astronomy) and what every nurse should concern herself with. The first rule of nursing is to "keep the air [the patient] breathes as pure as the external air, without chilling him," because foul air is the cause of disease not contagion but foul air:
Is it not a fact, that when scarlet fever, measles or smallpox appear among the children, the very first thought is "where" the child can have "caught" the disease. They never think of looking at home for the source of the mischief. If a neighbour's child is seized with smallpox, the first question which occurs is whether it has been vaccinated. No-one would undervalue vaccination; but it becomes of doubtful benefit to society when it leads people to look abroad for the source of evils which exist at home.
Florence Nightingale is here taking sides in an important medical controversy on the cause of disease, that between the believers in miasma and the believers in contagion. Miasma describes the state of the environment in general terms; contagion refers to something specific. The reason Nightingale resisted it so strongly is that it would introduce an element of pure chance into the battle between order and disorder:
The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of whitewashing; in one word, defective household hygiene. 22
These are the words of a moral crusader, and Charles Rosenberg has pointed out how central such moral fervour is to Nightingale's conception of nursing. 23 If we put our lives in order, we shall not catch scarlet fever or measles or
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