Bashford, Alison. Purity and Pollution : Gender , Embodiment and Victorian Medicine. New York: St. Martin's Press, Inc., 1998. 188 pages, illustrations on pages 13,29,118,143


Alison Bashford explores the cultural history of femininity, the concept of cleanliness and its moral and physical implications in Purity and Pollution. The identification of the female body with cleanliness and constant pollution is the central theme.
Public health and sanitary reform were popular mid-nineteenth century Victorian movements within the medical community. Medical establishments were overrun with the idea that sanitation was the most effective way to prevent the spread of disease. Dr. Benjamin Ward Richardson purported that sanitation must be present in each home, the place where true reform was to take place(1). Florence Nightingale, the figure head of the new standard of female nurses, designed sanitariums that would optimize the flow of air through wards and provide the most sanitary-friendly conditions possible(7). The assumption that sanitary conditions, both public and domestic, were vital to properly treat disease, led to the belief that the lower classes, who were surrounded by filth, in some way perpetuated disease and a lower state of morality.
Morality and health conditions became interconnected as sanitary reform progressed. The role of nurses and how they were viewed by society changed drastically. The old nurse was seen as an undesirable character who was working class, disheveled in appearance, crude in practice and out for personal gain at the expense of her patients. She was personified as Charles Dickens' Mrs. Sairey Gamp from Martin Chuzzlewit and embodied a lack of morality. The new nurse conversely was viewed as possibly being the epitome of morality, cleanliness and self sacrifice. She was now of the middle class, her appearance was impeccable, her uniform was always clean despite the many opportunities for it to become spoiled while helping a patient. This new view of the nurse personified sanitary reform. No one was more clean than the nurse.
Nursing became popular as a feminine form of philanthropy. Different social classes translated to different levels in the hierarchy of nursing staff and administration, but all social classes were included. Women of higher social class were able to selflessly devote themselves to a cause and work outside the domestic sphere. Upper class women received no wage for their duties and frequently made donations to various funds associated with their care. This practice eliminated the accompanying disgrace of an upper class woman holding a paid position.
Exposing oneself to diseases was a selfless act nurses performed countless times a day but ultimately this self sacrifice was viewed as a possible form of contagion. Feminists who pursued a standard medical education were not only subjected to the Victorian etiquette that would not allow a woman to examine a man but they, as well as midwives, were thought to spread disease and illness. Thus a distinction between the sexes was drawn. Eventually as the twentieth century approached, the practice of asepsis became common place and both male and female practitioners of medicine were seen to be possible causes of contagion and contamination. The distinction between the perceived competency and abilities of the two sexes was to some extent lessened but in no way abandoned.
This book clearly illustrates the history of women in the medical field and their role as nurses from the mid-nineteeth century until the early twentieth century. This text is not written for a biological audience seeking a description of techniques used in the medical treatment of patients. In actuality it discusses the role of the patient minimally and focuses on the and his or her role in medicine. Changing attitudes toward women are discussed as is their role as well as the constant dichotomy of 'purity and pollution' which the female body is seen to personify. The social role of women in medicine is explored in contrast to their male counterparts, both nurses and doctors.
The author approaches nursing, gender and its significance from a number of different vantage points. Its connection to nineteenth century morality, religion and secularism, gender roles and social reform are explored. The author's own feminist beliefs can be detected within the text but overall it is an objective presentation of the events and cultural conditions that existed during the period, and their relationship to the nursing profession. Insight into the daily routine of the Victorian nurse and its accompanying responsibilities is offered as well as the causes of change in the stigma associated with the profession.
The role of women in the medical establishment presents a new meaning to discrimination and its relationship to illness and disease. Although women were not necessarily discriminated against, they were held under a different set of standards than their male counterparts. Understanding the treatment of those who provide care can give insight into the treatment of those being cared for.