Book Reviews: Nursing Before Nightingale, 1815-1899

BOOK REVIEWS
Nursing before Nightingale, 1815–1899

By Carol Helmstadter and Judith Godden
(Farnham, England: Ashgate Publishing Ltd, 2011) (219 pages, $119.95 cloth)
In the “Introduction” of Nursing before Nightingale, authors Carol Helmstadter and Judith
Godden clearly express their purpose and rationale for debunking some of the myths that
exist around Florence Nightingale’s legacy. As Helmstadter and Godden point out, history
has tended to be traditional and revisionist when it comes to Nightingale. Traditional his-
tories and common perceptions portray Nightingale as single handedly causing nursing to
progress from the Dark Ages to a modern vision of an efficient, clean, and orderly nurse.
Revisionist accounts, which were popular in the 1980s, argued against the reputation of the
pre-Nightingale nurses such as Sarah Gamps 1 and claimed that they were “misunderstood
victims of history.” Nursing before Nightingale joins a recent body of Nightingale scholar-
ship that situates Nightingale within a transitioning nursing profession and demonstrates
that her success may have been in part because of a perfect timing and readiness for change
in nursing; and that many of her endeavors, in fact, included failures. 2 Nightingale’s name
itself began to carry an impetus for nursing reform that some scholars suggest may have
functioned as a label, which did not even necessarily represent Nightingale ideas. 3
Helmststadter and Godden make a compelling case for three points in the introduction: that
the transition from the “old” nurse to the “new” nurse was indeed a long and painstaking process;
that the Anglican nursing sisterhoods were the early designers of a systematic approach to
supplying trained nurses to the masses and including trained nurse driven leadership (as
matrons/superintendents); and that Nightingale and the “Nightingale system of nursing” and the
subsequent reform that it is associated with did, indeed, follow these earlier changes and may
have built on them rather than occurred parallel or separately from them. In addition, they also
reveal that Sarah Gamp was a very accurate depiction of some early 19th century nurses.
In particular, Helmstadter and Godden argue that change in nursing in the 19th cen-
tury ultimately came about as a response to changes in surgical and therapeutic practices
that demanded an improved quality of nursing care. The authors demonstrate that the
problems in quality of nursing care were addressed beginning in the 1810s, and several
modes of nursing reform were implemented with varying degrees of success. The book
describes some of the alternate models of nursing that arose, including the doctor-driven
ward system and the Central Nursing system of the Anglican sisterhood. The main thesis
of the book is posed as a question in the introduction; the authors ask, “Were the Anglican
nursing sisterhoods, now barely recognized as having ever existed, the progenitors of modern
nursing?” (p. xiii). Helmstadter and Godden conclude that yes, the Anglican sisters were.
Nursing History Review 21 (2013): 122–154. A Publication of the American Association for the
History of Nursing. Copyright © 2013 Springer Publishing Company.
http://dx.doi.org/10.1891/1062-8061.21.122
Book Reviews 123
Chapters 1, 2, and 3 explore early demands for change in quality of nursing care,
conditions of early 19th century hospital nursing, and the doctor-driven ward system of -
nursing reform, respectively. These chapters provide a base for the subsequent chapters.
They contain a vast amount of primary source information from various London hospi-tals
as well as Board of Governors meetings, which describe the persistent personnel and
management problems, and various efforts to correct them. Chapter 4 describes early nurse
training efforts. Chapters 5 and 6 examine the experience of nursing in the Crimea by
women of the upper and middle classes, including religious sisters, and by working class
women. The synthesis and analysis of primary source data reveal important data. For the
nurse of the lady class, the big problems were the lack of clinical experience and being
unaccustomed to taking orders from other ladies. For members of the religious sister-
hoods, there was a combination of problems; in some cases, a lack of experience. What
emerges in Chapter 6 is the importance that was placed on clinical skills and
experience. The description of a “clever nurse” was commonly used to evaluate nurses
who were clinically skilled but also showed signs of having good judgment, being
industrious, and being sober.
Chapters 7, 8, and 9 address the Anglican Sisters and St. John’s House and its influence on
nursing reform in England. One of the goals of developing the Anglican sisterhoods was to create
a systematic approach to training that would produce a steady supply of high
quality nurses. The St. John’s House achieved this through a lay sisterhood that allowed
varying degrees of commitment to the religious community. For example, they might be
married women or single women and choose to live in residence or at home. The sisterhood
only allowed upper-class ladies to join. A big difference, among the sisterhoods, was that
the Lady Superintendents produced by St. John’s House were nursing sisters and trained
nurses. This is very different from other systems of nursing solutions that were tried and
that failed in the early 19th century and in which the matrons or lady superintendents were
not trained nurses. These chapters also describe the ultimate demise of the Anglican sister-
hoods and their waning influence on nursing.
Nursing before Nightingale is an impressive piece of work in terms of the
primary source materials used and the synthesis and analysis of the authors’ argument,
but the book does leave some room for constructive criticism. It would have benefited
from a more clearly expressed plan of constructing its argument. However, it should
be noted that the conclusion is concise and clear. Here, the authors discuss the
relevance of each chapter to the main arguments of the book. If you like to examine a
book from a methodological perspective, reading the conclusion first is recommended.
Nursing before Nightingale is part of the Ashgate publishing series entitled “The
His-tory of Medicine in Context,” edited by Andrew Cunningham and Ole Peter Grell,
both of the University of Cambridge. Ashgate describes the series as
cutting-edge scholarship on a range of medical subjects that cross chronological,

geographical, and disciplinary boundaries. The series consistently challenges received
views about medical history and shows how medicine has had a much more pro-
nounced effect on western society then is often acknowledged. 4
Helmstadter and Godden carry out these goals very successfully.

This book is fascinating and informative and will appeal to many audiences. It will be
of interest to historians of nursing, class, gender, women’s labor, medicine, and the world
124 Book Reviews
of 19th century England. It will also have appeal for Nightingale enthusiasts,
Nightingale scholars, and a general audience.
Notes
1. Sarah Gamp is a fictitious character created by Charles Dickens. The

character in Dickens’ Martin Chuzzlewit captured the stereotypical character of the
inebriated early 19th century nurse.
2. For example: Robert Dingwall, Anne Marie Rafferty, and Charles Webster, An In-
troduction to the Social History of Nursing (London: Routledge, 1988); Judith Godden, Lucy
Osburn, a lady displaced: Florence Nightingale’s envoy to Australia (Sydney, Australia: Sydney
University Press, 2006); Sioban Nelson and Anne Marie Rafferty, eds., Notes on Nightingale:
The Influence and Legacy of a Nursing Icon (Ithaca, NY: Cornell University, 2010).
3. Joan E. Lynaugh, “Rhetoric and Reality in America,” in Notes on
Nightingale: The Influence and Legacy of a Nursing Icon, ed. Sioban Nelson and
Anne Marie Rafferty, 76–90 (Ithaca, NY: Cornell University, 2010).
4. Andrew Cunningham and Ole Peter Grell, “The History of Medicine Series in
Context,” http://www.ashgate.com/default.aspx?page=1289&lang=cy-GB (accessed
February 17, 2012).
Kathleen Mary Nishida

Doctoral Student
University of Pennsylvania
418 Curie Blvd.
Philadelphia, PA 19104
James Young Simpson: Lad o’ Pairts

Edited by Alison Nuttall and Rosemary Mander
(Renfrewshire, Scotland: The Scottish History Press, an imprint of
Kea Publishing, 2011) (224 pages, £19.95 paper)
The “lad o’ pairts,” was an ideal encouraged by the Scottish educational

system of the nineteenth century: a boy should strive to be an all-rounder, a
pioneer, broad in knowledge and at the same time practical.
(http://archives.queensu.ca/Exhibit/ buchan/ladopairts.html)
In Spring 1993, I spent a 3-month sabbatical at the University of Edinburgh with Rose-
mary Mander as my mentor/liaison. I collected data at the Simpson Memorial Pavilion, the
maternity wing of the Royal Infirmary of Edinburgh. A large portrait of James Young
Simpson, an eminent Victorian obstetrician and professor of midwifery at the University of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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BOOK REVIEWS

Nursing before Nightingale, 1815–1899

cutting-edge scholarship on a range of medical subjects that cross chronological,

Helmstadter and Godden carry out these goals very successfully.

1. Sarah Gamp is a fictitious character created by Charles Dickens. The

Kathleen Mary Nishida

James Young Simpson: Lad o’ Pairts

The “lad o’ pairts,” was an ideal encouraged by the Scottish educational

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