Hektoen International

A Journal of Medical Humanities

Saints on trial

Michael Shulman
New Hope, Pennsylvania, United States

 The Lady with the Lamp

There is an irresistible sub-genre of literature devoted to the moral takedown of saints and would-be saints, and it has brought forth contributions from some of the masters of English prose. One thinks especially of George Orwell’s portrait of Gandhi (“Saints should always be judged guilty until they are proved innocent.”)1 Not as widely known, perhaps, but deserving of a niche in this pantheon, is an essay on Florence Nightingale by Lytton Strachey, who along with John Maynard Keynes and Virginia Woolf belonged to the austerely literary Bloomsbury Group. Strachey’s essay appears in the volume Eminent Victorians, which he published in 1918.2 For lucidity of style and ferocity of purpose, it sets a high standard.

Florence Nightingale is introduced in Strachey’s essay as a member of the English upper class who grew up in a large country estate in Derbyshire. Even in childhood, she occupied a spiritual plane above her peers. A compelling inner voice convinced her as a toddler that she had been summoned to a higher calling. When her sister tore to pieces the dolls in the nursery they shared, Nightingale pounced upon the dolls and sewed them up again.

When her family objected to a career in nursing as déclassé, Florence Nightingale became a volunteer in the workhouses and slums of London. Only at age thirty-three, after four months of medical training, was she employed as superintendent in a nursing home in Harley Street. When the Crimean War broke out in 1853, she was asked to form a cadre of nursing assistants to tend to the fallen British troops. Unhesitatingly, she gathered her flock and set sail for Scutari, a municipality of Istanbul.

Nightingale was now launched irrevocably on her career as the mythic “Lady with the Lamp.” When she arrived in Scutari, the military hospital was under the command of an ancient aristocrat who had resisted every attempt at innovation. Injured men were being dispatched to the hospital across the Black Sea in groups of 200, conveyed aboard vessels that provided no beds, blankets, or medical stores. The hospital itself, set over a hodgepodge of sewers and cesspools, was an unventilated barrack-house swarming with vermin and permeated with evil smells. Arrangements for cooking and laundry were “a farce.” The army physicians were incompetent, enfeebled by age, or demoralized to the point of paralysis.

To this inferno, Florence Nightingale brought order, common sense, and a stream of supplies importunately solicited from the Army Medical Board, or where necessary, purchased with her own funds. Towels, soap, and clean linen made a magical appearance. Consignments that had previously sat untouched for weeks awaiting an authoritative signature were opened forthwith. A system of rationing was imposed on the kitchen. The mortality rate for British soldiers on the frontline fell from 42% to twenty-two per thousand. Most enduringly of all, her implacable will now reigned unchallenged where the military bureaucracy had achieved only lassitude and despair.

And yet for Strachey, this was precisely the sticking point – her consuming, uncompromising, and indomitable will. Like the territorial ambitions of the imperialist Victorians, her will could not be contained. Returning from the Crimea, Nightingale strove to revolutionize the homeland military hospitals by duplicating the reforms she had previously introduced to so much acclaim. When her opponents made common cause against a female interloper, she moved to revolutionize the whole apparatus of organized medicine in Great Britain. Her means to this end was to cultivate an image of feminine modesty, to elevate herself as an object of idolatry, and then to rely upon persuasion, influence, and public opinion to destroy her detractors. The whole of the British Empire had been built just so.

There is no finer writing than that contained in Strachey’s portrait of Nightingale, but it is instructive, after savoring it, to take up George Orwell’s rather different but equally entertaining portrait of Gandhi.1 What emerges from the contrast is an understanding that would-be saints might be justly regarded in two ways. Strachey’s prose, in its gorgeous and florid excess, bends toward gossipy sniping. He cannot be reconciled to the distressing fact that Florence Nightingale, the model of maidenly Victorian charm, was a brawler who “tasted the joys of power.” Her late senility, as he paints it, was a fitting punishment for her pride.

Orwell’s artfully modulated prose offers another view. It is true that Gandhi was insufferably self-righteous. He advocated not only chastity, but the suppression of all sexual desire and the repudiation of ordinary friendship. Unyielding in his pacifism, he called upon Germany’s Jews, in 1938, to commit collective suicide. And yet, Gandhi’s preaching of non-violence prevented a bloody rebellion in India, thereby saving many thousands of lives.

Orwell, recognizing this complex picture, is generous in celebrating Gandhi without pretending to like him. As a commander during the Spanish Civil War, Orwell had been in battle and had seen men die by his hand. He considered sordidness a part of getting the job done. Strachey was, in contrast, a quintessential aesthete. He was able to admit, passingly, that “if Miss Nightingale had been less ruthless… she would not have been Miss Nightingale.” But he did not conclude from this that what was repellent in her nature was also what allowed her to be a devoted Samaritan, if never a selfless spirit from another world. Might it be true that self-importance is not a blemish on saintliness but, in our fallen state, a different facet of the same imperfect gem? Like other moral questions, this one is unanswerable. But as these imperishable essays make clear, we will have to revere our saints for the good they do, and not hope to discover, when we come to know them, that they have been spared flaws much like our own.


  1. Strachey L. Florence Nightingale. In:Eminent Victorians. NY: Simon and Schuster, 2012.
  2. Orwell G. Reflections on Gandhi. In: The Orwell Reader: Fiction, Essays, and Reportage. NY: Harcourt, 1984.

MICHAEL D. SHULMAN, MD, PhD, holds a PhD in clinical psychology from Fordham University and a medical degree from the Perelman School of Medicine at the University of Pennsylvania. He is retired from the private practice of nephrology.

Highlighted in Frontispiece Volume 10, Issue 4 – Fall 2018

Winter 2024



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