Medical Women and Victorian Fiction (review)

Historians and interdisciplinary scholars will find this study of nineteenth-century Victorian literature on medical women illuminating. Primarily a literary scholar, Kristine Swenson has done her homework, digesting an array of social-historical literature on British nurses and women physicians, as well as key texts on nineteenth-century social transformation and the emergence of the empire. Swenson shares Mary Poovey's insistence that a combination of history and textual analysis can enhance our understanding of the past, and her skillful interpretations of the Victorian fiction written about medical women enrich our perceptions of the entrance of women into medicine. Swenson's "medical women" are nurses as well as doctors, because Victorian society grappled first with the social implications of the "reformed" nurse, whose cultural construction later linked her in complicated ways to the more feminist woman doctor.

Swenson begins her narrative with the Crimean War, which provided a platform for an individual such as Florence Nightingale to map pressing social problems—including disease, pauperism, prostitution, and social degradation—onto a more active social role for working- and middle-class women. Capitalizing on the significance of gendered domesticity in all its ramifications, Nightingale contributed to the "condition-of-England" debate by making a case for the deployment of the reformed nurse in the project of social rehabilitation. She argued that nursing could provide respectable employment for both working- and middle-class women, and her construction of the profession carried significant cultural power. As angels of mercy, nurses were to embody the gendered moral influence of the domesticized wife and mother—qualities especially valued in an anticontagionist medical climate that still associated disease with immorality. The professionalization of nursing could also solve the problem of superfluous women—the population imbalance between the sexes, the decline in suitable employment for women brought about by industrialization, and the consequent rise in prostitution, urban slums, and working-class debauchery.

The moral crisis catalyzed in England by the Crimean War gave Nightingale's advocacy persuasive power. Yet it also elicited huge cultural anxiety about gender roles, which found its way into mid-century Victorian fiction. Victorian novelists such as Elizabeth Gaskell, Charles Kingsley, Wilkie Collins, Charles Reade, and Charles Dickens grappled, not simply with social disruption, but with new conceptualizations of women's place. Fictionalized versions of the reformed nurse appeared in several popular medical romances. Swenson argues that a large portion of the reading public derived their attitudes from contemporary fiction. This literature was haunted by the potential for independence that was afforded nurses in Nightingale's program, signified primarily by paid employment, which evoked long-standing fears of undisciplined female sexuality. Though Nightingale asserted nurses' value to empire and society with eloquence, mid-Victorian fiction tended to police the boundaries of nursing careers, often through the conventions of Victorian courtship, romance, marriage, and family. Nightingale's own ambivalence, especially her insistence on strict discipline and the subordination of nurses to physicians' authority, made her an inappropriate advocate for female equality in medicine.

The second half of Swenson's book is devoted to the emergence of the scientifically knowledgeable woman doctor, a figure who, both in British society and in literature, was represented as someone who could compete with male doctors on her own terms. Women doctors built on the positive images that Nightingale had achieved for reformed nurses, but discarded her separate-sphere arguments in favor of becoming New Women. They asserted the right to professional, personal, and economic power, and they appropriated the authority of science. In the process, they became emblematic figures in the fiction of the emancipated woman, some of it written by women physicians themselves. Here Swenson explores the complicated conditions under which British society came to accept the woman doctor, and the reciprocal relationship of modernity, the imperial context, and women's exercise of agency. In a final chapter on medical women and the empire, she makes a convincing case for the role that these women played in carving out...