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Louise Penner. Victorian Medicine and Social Reform: Florence Nightingale among the Novelists. New York: Palgrave Macmillan, 2010. ISBN: 978-0-230-61595-3. Price: US$80.00/£55.00

  • Maria Frawley

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  • Maria Frawley
    The George Washington University

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It is no longer necessary today to begin a book on Florence Nightingale—or a review of such a book—by contesting the once received image of the angelic lady with the lamp. Deserving neither hagiographic adulation nor the mockery and scorn that Lytton Strachey famously heaped on her in Eminent Victorians (1918), Nightingale is a complicated figure whose writing and life work continue to attract the robust scholarly interest of biographers, historians, and, in Louise Penner’s case, literary critics. Penner’s approach makes use of a few key Nightingale biographies (especially those of Mark Bostridge and Hugh Small) as well as of Nightingale’s relatively well-known published works such as Notes on Nursing (1860), Notes on Hospitals (1859), and Suggestions for Thought after Truth among the Artizans of England (1860), but yokes these resources to material newly available via Lynn MacDonald’s sixteen-volume work-in-progress, Collected Works of Florence Nightingale. Rather than showcase an individual blazing trails for those who followed her, Penner wisely aims to demonstrate that “Nightingale shared ideals about governance and reform in common with reformist essayists, philanthropists, and novelists of her time” (3), even while she critiqued a variety of their philosophical or scientific positions.

The value of this approach is that it helps readers appreciate a figure influenced as much by a life lived “here, now, in England” (to quote from George Eliot’s Middlemarch [1871-72], a novel that looms large in this study) as by the Crimean War that established her moral authority and status as national heroine. More specifically, Penner turns frequently to the literature of the period to contextualize Nightingale’s ideas and writing. Influence is not, in Penner’s hands, a one-way street; the traffic flows in both directions as she studies the fiction writers who most directly shaped Nightingale’s thought and assesses the impact of Nightingale on her contemporaries. These fiction writers—including Charles Dickens, Elizabeth Gaskell, and Eliot, but also the Evangelical writer Hesba Stretton and the sensational novelist Wilkie Collins—provided Nightingale with a treasure trove of rhetorical strategies which she adapted for different audiences and purposes.

Nowhere does Penner make more of the disparate audiences that Nightingale wrote for than in her analysis of Notes on Hospitals and Notes on Nursing, the first written for government bureaucrats and the latter for middle-class women. She persuasively claims that the rhetorical differences between these key texts indicate “Nightingale’s willingness, particularly when addressing women, to exploit the fears that her texts were ostensibly written to alleviate” (11). To demonstrate the extent to which Nightingale deployed a narrative technique and agenda gleaned from sensation fiction (i.e. the desire to exploit fear), Penner identifies a rhetoric of dispassionate observation and vigilance pervasive in this subgenre of fiction and suggestively demonstrates the sensationalism of Nightingale’s analogous battle with intruders (“the intruder representing, of course, disease in general” [26]). Penner compares Nightingale’s attitude and stance to that of Walter Hartright, Collins’s central narrator in The Woman in White (1859-60), a novel peppered with ideas of cleanliness and contagion that, she contends, echo Nightingale’s own.

Penner is nevertheless on firmer ground when discussing those who more directly influenced Nightingale, especially in terms of her reformist impulses and efforts. The second chapter, a study of Nightingale’s interest in Poor Law reform, shows how she sought to promote efforts that would encourage economic independence among the pauper class, with government-provided opportunities for education and remunerative work. It focuses primarily on Dickens and Stretton, whose works were openly admired by Nightingale and distributed to the military men and nurses with whom she worked. Perhaps out of a perceived need to distance herself from the celebrity-seeking “lady philanthropists” (46), Nightingale published only a small portion of what was evidently her voluminous writing on Poor Law reform and philanthropy. Penner studies this writing in relation to mid-century governmental records related to the alleviation of poverty, as well as to the many fictional accounts of urban distress or biographies of female social reformers that Nightingale bought and donated to charitable institutions. Nightingale wrote approvingly of Agnes Jones, Octavia Hill, Mary Carpenter, and Caroline Chisholm, and became something of a one-woman circulating library of their works. But she was also a devoted fan of Dickens, and purchased copies of Bleak House (1852-53) for various charities. Nightingale also admired Stretton’s fiction enough to catalogue and annotate it, claiming to have found “all but 6 or 7” of the stories useful for her own purposes (74). Penner focuses on Stretton’s work titled Bede’s Charity (1872), short fiction that provided Nightingale with competing models of charity, and on A Thorny Path (1879), a work with inspiring “pictures of the heroism of typical children and adults who care for the members of their communities” (73).

Readers eager for a more discriminating, feisty, even reactionary Nightingale will be rewarded by the third chapter, which tackles Nightingale’s hostile reaction to Middlemarch. In part, Penner contends, Nightingale was deeply disappointed with the central heroine Dorothea’s “failed idealism” (77). Penner quotes Nightingale in a letter to Benjamin Jowett angrily lamenting that the novel’s “object is to pronounce aspiration impossible” (78). Penner digs deeper to uncover the roots of a response that she justifiably sees as virulent and excessive and finds that Eliot’s novel

comments critically on many of the principles that Nightingale held dear: the importance of sanitary principles to social, economic, and health reforms, the statistical studies that she thought revealed those sanitary principles, and the need for science and politics to subordinate theoretical speculations to fact and substitute action for words.

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Penner is appropriately attentive to Middlemarch’s status as a historical novel set in the early 1830s, particularly through discussion of Pierre Louis (a physician who challenged the single-fever theory and who is mentioned in the novel as Lydgate’s teacher) and Francois Broussais (another of Lydgate’s teachers, one associated with positivist medical research). Ultimately Penner concludes that Nightingale’s intense hostility to Dorothea enables her to avoid confronting the “all the ways the imagination of Dorothea’s creator challenged her own views” (107).

The direction of Penner’s book shifts somewhat in her last full chapter, turning from the representation of medical advancement in the provincial world of Middlemarch to a more decidedly international stage—India and the Madras famine of 1876. This chapter returns to earlier emphases of the book, uncovering the rhetorical strategies Nightingale employed to galvanize the British reading public and the government. Penner claims that Nightingale found in Condition of England novels—most written in the 1840s and 50s—the appropriate rhetorical strategies needed to address the problems of British apathy, misunderstanding, or fear of what was unfolding in India. Moreover, as Nightingale’s understanding of the roots of famine shifted, and as she came to embrace Indian home rule, she adapted and developed appropriate rhetorical strategies. In Nightingale’s representation of India’s poor and their plight—“overcrowding, unsanitary living conditions, epidemic disease outbreaks, low wages, unavailability of work, and starvation” (134)—one can glean the influence of Dickens’s and Gaskell’s social protest literature, especially Mary Barton (1848). The similarities between Gaskell’s novel and Nightingale’s writings on India reveal her “ability to recognize how public fears might be soothed by paternalistic calls for sympathetic identification with sufferers, while at the same time insisting on the heroism of those who struggle to take care of themselves and their community” (146).

In a letter to her father in June of 1868, Nightingale described her dear friend Benjamin Jowett’s life as “a perpetual struggle with destiny.” Nightingale here projects her own anxieties about celebrity, fame, legacy, and influence onto Jowett. Most of the scholars who grapple with Nightingale suffer from a similar burden, taking up their subject’s “struggle with destiny” only to conclude, as Penner does, that “there is no one way to describe her complex legacy” (147). Of course not, one might add. So despite Penner’s closing and largely futile attempt to address “the legend versus the life” (147) she better serves her subject in the book’s main chapters, where she establishes Nightingale’s distinctive place “among the Novelists.”

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