Say Little, Do Much: Nursing, Nuns, and Hospitals in the Nineteenth Century (review)

When it comes to professional nursing, there are many blind spots. Indeed, when it comes to serious scholarship about nursing, it can be argued that invisibility and erasure are metaphors for nursing. Say Little, Do Much addresses a "blind spot" (p. 2) that has made invisible the contribution of religious nurses to the professionalization of nursing. Concentrating on vowed Christian women in Australia, Britain, and North America (the book does not address the contributions of Jewish, Muslim, or other religious women in English-speaking or other countries), Australian scholar Sioban Nelson contends that historians of and advocates for nursing have sought to escape the historical fact that religious nurses shaped modern nursing because of their association with obedience and submission. The religious heritage of nursing is one of the key factors that has made it an anomaly among professions and a poor fit with existing models of professions.

Nelson hopes to relocate the emergence of modern nursing in the religious and pastoral domains of nineteenth-century society. She argues that the secularization of nursing history has obscured the work that religious women performed to "colonize new territory" (p. 5) for women in the world of work. These vowed women may have said little, but they did much to transform the care of the sick into a respected profession for women. She presents five case studies of religious nursing in the English-speaking world from four confessions: Roman Catholic, Anglican, Lutheran, and Methodist.

In "Martha's Turn," Nelson describes how nineteenth-century pious women moved their work into the public domain. She argues that it was precisely those attributes most antithetical to gender-conscious contemporary values—conservatism, submission, and asexuality—that empowered these women to be pioneers, and to challenge the Nightingale view of nursing history that portrayed nursing as having evolved from religious ignorance to enlightened expertise. Indeed, Nelson contends that it is as impossible to understand nursing without religion as it would be to understand it without gender. In "Free Enterprise and Resourcefulness," she tells the story of the Daughters of Charity in the United States. Their work in epidemics, slums, and war allowed them a measure of independence and power while they "walked a careful path of obedience and independence on the bishop's soil" (p. 55).

In "Behind Enemy Lines," Nelson examines religious nursing in England and shows its influence on what came to be known as the Nightingale system of training and hospital reform. In "At the Margins of the Empire," she moves to her home country of Australia to show how hospital nurses struggled against the limitations of female influence and authority, and how men in authority struggled to reassert their control. In "Frontier," she turns to the hospital-foundation work of religious women in San Antonio, Texas, and the Pacific Northwest to show how working on the frontier furthered their institution-building. In "Crossing the Confessional Divide," Nelson examines German Catholic and Protestant nurses in the New World.

Say Little, Do Much is a meticulously referenced work that both says and does much to reinstate religious Christian women as cofounders of professional nursing and modern health-care systems. As important a contribution to nursing history as it is, its more important contribution might well be to demonstrate again that history often tells us more about the present—"about what we choose to study and care to reveal about our collective past" (p. 29)—than it does about the past. History is a reflection of human desires and choices, and Nelson shows us how a profession yearning for visibility and eager for acceptance as a scientific profession might want to re-story its religious origins.