Tuesday, October 4, 2016

Book Review: Julia Stephen's "Notes from Sick Rooms"

One could be forgiven if the name Julia Stephen fails to ring a bell. She occupies the footnotes of biographies of better known Victorians, such as Edward Burne-Jones, for whom she modeled as a young woman, and her daughter, Virginia Woolf. In her lifetime, she was more than well-liked: Woolf wrote that, in later years, acquaintances were moved to tears when remembering her mother, but Woolf herself did not see Stephen, the quintessential angel in the house, as a figure to emulate. While Stephen signed a notorious petition in 1889 against women's suffrage, Woolf would go on to become one of the foundational figures of modern feminism, as the author of A Room of One's Own and Three Guineas. Interestingly, Woolf wrote that Stephen left behind her no concrete legacy and indeed Stephen never worked professionally. She was a loving wife, an adoring mother, a devoted daughter, and much in demand as a (strictly amateur) nurse, in an age when the professionalization of nursing was much discussed, but still controversial. But Stephen was also a published author; her Notes from Sick Rooms was published in 1883, the year after Woolf's birth.

It is highly unlikely that this slim volume of commonsensical advice for those looking after ill family members would be remembered or available if Stephen's daughter hadn't been Virginia Woolf, but she was and thus Notes from Sick Rooms is in print, paired with Woolf''s essay On Being Ill, from the Paris Press. It is not an especially literary work. Unlike Florence Nightingale, Stephen was not given to flights of poetic fireworks, but she has a wry, too practical to be coquettish sense of humor. The book is made up of short pieces, each on a subject of importance to the nurse, such as "Washing," "Visits," and "Remedies." Stephen advocates for a radically patient-centric approach to nursing. Each piece of advice is intended to lighten the patient's misery and thus she spends considerable time on issues that medical professionals, even today, would not consider of especial import. For example, Stephen devotes a section to the subject of "Crumbs," which, as anyone who has ever spent a compulsory period in bed knows, are "the greatest... among a number of small evils which haunt illness." With a typically dry tone, Stephen exhorts the nurse that "she must first believe... I have crumbs in my bed" or else she will fail to eradicate them properly. This particularly wry section recalls, more than any other in Notes, Woolf's pithy and delicately sarcastic sense of humor, for instance in her description of the official clothing of archbishops, generals, judges, and the like in Three Guineas. This one long paragraph is a small, schoolmarmish masterpiece.

Much of Stephen's advice is outdated, for instance, her concern about keeping a fire going at all times, so as to have easy access to hot water and warmed towels, and much of it is, frankly, a bit terrifying. Stephen endorses macaroni as a substitute for vegetables and recommends as a diet for the patient afflicted with nausea "cold quenelles or cold fowls, boiled or roast, with thick cold white sauce or a beef-tea jelly," which will supposedly go down easy while "any hot food would create disgust." Indeed, beef-tea jelly is oft mentioned in Notes and she even includes a recipe, which made me devoutly glad not to be under her care.

Some of her advice, however, is still quite useful. Her comments on making a bed comfortable or changing the sheets for a patient who cannot get up are as applicable today as they were 150 years ago and her admonition to avoid both "an unnatural gravity or cheerfulness," either of which are quite frightening for someone who is already ill and worried over what further tortures may be in store is sound advice. She also offers excellent instructions on massaging someone, relieving bed sores, and washing a patient while leaving her in bed. Stephen's main point is that a good nurse "should look on her patient as a 'case,' nursing with the same undeviating tenderness and watchful care the entire stranger, the unsympathetic friend, or the one who is nearest and dearest."

Such a view of the nurse is quite lovely and recalls in softer terms Nightingale's avenging angel or Clara Barton's angel of the battlefield. It is also an intensely gendered image of nursing. Historically speaking, it makes perfect sense that Stephen assumes in all cases that doctors are male and that nurses are female, and usually untrained. Elizabeth Blackwell and a tiny coterie of similarly ambitious women became doctors in the 19th century, but they were exceptional to say the least. Nevertheless, I rather take issue with the way in which Stephen's perfect nurse mirrors so precisely the angel in the home, that Victorian paragon of selflessness, self-abnegation, and silent suffering, the creature that Woolf determined to kill in "Professions for Women" in order to set herself free from the tyranny of respectable, domestic womanhood. It is worth noting that Woolf claimed she could not recall ever being alone with her mother except during childhood illness. Stephen, clearly an intelligent, witty woman with decades of expertise caring for the sick, would have been scandalized at the idea of becoming a doctor, for instance, or a public intellectual, though she spent her life nursing and writing publicly about it. If Woolf dismisses Notes from Sick Rooms so easily, this could be the reason: Stephen remained bound to a vision of womanhood that superseded her individuality as a person.

The conclusion of the book may (despite the beef-tea jelly) prove the most shocking to the modern reader. Stephen matter-of-factly addresses how the nurse ought to behave when the patient dies. She describes how to properly lay out the body, so as to spare the mourning family as much as possible, and she sternly insists that the nurse must remain quiet, composed, and unhurried, for "in the presence of death all bustle is unseemly." Though death is as ubiquitous today as it was in the Victorian era, it is increasingly rare for people to die at home, cared for by family members, rather than in a hospital, hooked up to monitors and IV poles, surrounded by hordes of professional caretakers. It is our attitude towards death, rather than its reality, that has changed. Death is tastefully kept behind curtains and closed doors. Professionals wash, dress, and lay out or cremate the body, it rarely even being seen by family, except by those whose religious practice dictates a wake. Stephen's easy confrontation with death - which is not to say she was cold; she suffered cruelly the death of her first husband - is, I believe, a rather more salutary attitude than our own hidden, despairingly existential fear of mortality. But wait, one might say, surely it must have been easy for a pious Victorian lady with the hope of heaven before her to face death? Indeed, not at all: Julia Stephen, like her husband and daughter, was thoroughly agnostic and faced death with peace and pragmatism, though she believed in no heaven.

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