Ward is a fascinating figure: niece of Matthew Arnold, aunt of Aldous Huxley, a lifelong champion of the poor and of women's education, and a vocal leader of the movement against women's suffrage. Here she turns her attention to the spiritual, moral, and physical illness of the rural poor, whose lodgings were an "unhealthy" "disgrace" and whose employment and educational prospects little better. Although her social realism suffers from sentimentality, Ward deftly evokes the political arguments of her time over public health, landownership and poaching, Socialism and Venturism, labor reform, striking workers, a fair press, gambling, and spirituality in public life.

In the early death of Marcella's schoolfriend, the consumptive Mary Lant, Ward offers a parallel to the figure of Helen Burns in Jane Eyre; and in her portrait of Marcella as a passionate, intellectual woman, unsure of love but committed to public health reform in the rural villages, Ward presents a more radical version of Dorothea Brooke in Middlemarch (see annotations in this database). Ward's portrayals of puerperal fever, an alcoholic physician, and a murderous attack by a drunken husband illustrate contemporary medical debates and the problems which the newly professional figure of the nurse must surmount.

Ward's novel struggles, however, with her conflicting take on gender roles. Ward clearly valorizes Marcella's passionate defense of the poor and willingness to violate class and gender norms in pursuit of that defense (Marcella lives with Hurd's family while nursing them, and attends the trial in defiance of convention). But Ward also exposes Marcella's naïve romanticization of the poor and disparages her views as "womanly," irrational, and uninformed (Ward's arguments against suffrage as well). Her implicit criticism of Marcella's emotionally-distant mother suggests Ward's overall acceptance of a cultural norm that finally replaces Marcella in the role of fiancée to the wealthy, powerful Raeburn and forecloses the possibility of her independent life in practical social service, as a nurse to the desperately poor.

Although no one in Marcella's world ever discusses Nightingale's drive to professionalize nursing, the families and neighbors of patients refer to Marcella the nurse as "the young person" instead of "the young lady," showing that the "new" nurse still suffered from a class-and gender-based image problem. And although many of Marcella's friends praise her efforts as "noble," it is clear that they, and Ward, want to return her to her rightful place (and "greater work") as an adjunct to Raeburn's wealth and power.