Nursing before Nightingale, 1815–1899 by Carol Helmstadter and Judith Godden (review)

Two figures loom large in the history of Victorian nursing, and this is partly because they loomed so large at the time. One is Charles Dickens’s Sarah (or Sairey) Gamp, a nurse who features in The Life and Adventures of Martin Chuzzlewit (1843–44). Dissolute and drunk, the character became a notorious stereotype of the bad nurse in the early Victorian era. Umbrellas even became known as gamps, after her own, which she displayed with “particular ostentation” and clutched and shook in the course of delivering her lines (Dickens, The Life and Adventures of Martin Chuzzlewit [Chapman and Hall, 1844], 559). The other, of course, is Florence Nightingale—the Victorian, anti-Gamp heroine, in so many respects—who remains an icon of the nursing profession. Famously, for she was granted considerable publicity at the time, Nightingale made her name during the Crimean War at the Scutari Barracks, where she arrived in 1854 with a band of over thirty volunteer nurses to care for dying and diseased British soldiers. She then went on to found a nursing school in 1860 at St. Thomas’s Hospital, London, where, so the story goes, she laid the foundations of the modern nursing profession. The story continues to be told today: 2010 was, among other things, the United Nations’s International Year of the Nurse, chosen because it marked a hundred years since Nightingale’s death.

Gamp was a fictional character who contained an element of truth. Certainly many early Victorian nurses were Gamp-like: cack-handed, clinically inept, and even cruel. Nightingale, by contrast, was very real, and there is no denying the impact that she had on the profession, giving rise to what is sometimes dubbed the Nightingale model of nursing, based on the disciplinary figure of the matron. But as Nursing before Nightingale demonstrates, she remains something of a fictional figure, at least in historiographical terms. If she did indeed pioneer modern nursing, was all that preceded her really so hapless? And what else was on offer—was Nightingale nursing the only nursing game in town? The picture presented in Carol Helmstadter and Judith Godden’s new book is of a complex world of alternative nursing systems, Christian denominational politics, class prejudice, shifting medical imperatives, and ongoing struggles for status and recognition. Thanks to the pioneering work of Christopher Hamlin, we now have a more nuanced, critical appreciation of the achievements of Edwin Chadwick, another colossus of Victorian welfare. Thanks to Helmstadter and Godden we now have one of Nightingale.

Arguably, Nightingale revisionism began as long ago as 1918, when she featured in Lytton Strachey’s Eminent Victorians, where Strachey sought to add some biographical colour to the “popular conception” of a “saintly, self-sacrificing woman” (Oxford University Press [2003], 97). More recently, critical work since the 1980s has sought to examine the precise achievements of Nightingale, beginning with two notable volumes on the historiography of nursing, Celia Davies’s edited collection Rewriting Nursing History (1980) and Christopher Maggs’s edited collection Nursing History: The State of the Art (1987). At least two features distinguish Nursing before Nightingale. One is the breadth of the archive it draws upon, which includes the repositories of twelve London teaching hospitals, thus encompassing much beyond the records of St. Thomas’s. The second is the attention paid to other nursing systems, two in particular: a set of early Victorian, largely doctor-driven initiatives, which came to be called the ward system; and the reforms of the Anglican Sisters, which began at St. John’s House in 1849, known as the central system. Far from kick-starting nursing reform, argue Helmstadter and Godden, the Nightingale model is best viewed as the culmination of these two earlier developments; and if anyone might be dubbed the true anti-Gamp heroine, then it is Mary Jones, superintendent of the St. John’s Sisters, who first arrived on the scene in 1853.

The Sisters, write Helmstadter and...