37. Bedside Manner Transcript

Caroline: Detective fiction works best when there are rigid structures that can be obeyed, subverted or undermined. The closed circle of suspects, the unbreakable alibi, the pact to play fair by the reader — all of these restrictions help to stimulate writers’ creativity. The presence of certain archetypal characters is part of this too, especially in crime writing from the 1920s and 30s. The detective, the Watson, the red herring, the least likely suspect, the elderly miser, the suspiciously hard up wastrel and so on are all very familiar to fans of whodunnits from this period. That classic Cluedo formula — Colonel Mustard in the library with the candlestick — didn’t come out of nowhere.

One of these character archetypes that never gets enough attention, I feel, is that of the nurse. She’s a regular presence in golden age detective fiction, providing crucial evidence in a poisoning plot or emerging as an unlikely suspect, but it’s not often that she gets to stand centre stage. There’s a wealth of fascinating historical change to the nursing profession reflected in these books, too if you only know to look out for it.

Today, we’re going to work on our bedside manner.

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Welcome to Shedunnit. I’m Caroline Crampton

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In real life, the role of nurses in Britain was changing rapidly during the period that detective fiction was growing in popularity. Florence Nightingale had come to prominence during the Crimean War in the 1850s, advocating for better organisation and training of nursing staff who could treat wounded soldiers more effectively. In 1859 her book Notes on Nursing was published, which set out principles of sanitary care and treatment that could be applied in the home or in a hospital setting. Her public profile and cultural cachet in Victorian Britain helped attract funding, and the following year the Nightingale Training School opened at St Thomas’s Hospital in London. It provided a year’s residential training for student nurses, one of the first institutions of its kind to do so. By the time The Moonstone by Wilkie Collins was published in 1868 — which is often considered to be one of the first full length detective novels — the first few cohorts of Nightingale nurses were working in institutions around the country. The successor training schools to that first foundation still endure today, and in 1971 they acquired a connection with detective fiction when PD James published a mystery novel that was set in a nursing school called Nightingale House. Titled Shroud for a Nightingale, this dark, spooky mystery sees her detective investigate why student nurses are being bumped off before they can finish their course.

But back to the nineteenth century for second. To understand what these first Nightingale nurses, with their pristine uniforms and evidence-based training, were replacing, we don’t have to look much further than a character like that of Mrs Gamp in the 1844 Charles Dickens novel Martin Chuzzlewit. She’s a caricature of an untrained, sloppy, frequently drunk practitioner, who cares far more about what she can get for herself than she does about the health of her patients. The starched white caps of the women who trained at the Nightingale School stand in stark contrast to the battered black umbrella that Mrs Gamp always carried with her.

The first two decades of the twentieth century saw a crucial moment of transition for nursing. From Nightingale’s beginnings, which were funded by public donation and therefore leaned heavily on her own public profile, a more organised and professional system of training and practice was emerging. At the same time, the nature of healthcare itself in Britain was changing. Whereas before anyone could call themselves a “nurse” (including the Mrs Gamps of this world), the role was rapidly becoming codified and regulated as part of the medical profession. All of this influenced the nurse characters we see in whodunnits, and indeed it’s possible to track some of these changes through the ways they are reflected in detective fiction.

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But before we get on to the nurses of detective fiction, let’s dig a little deeper into what was happening for their real life counterparts. How would a young woman even go about becoming a nurse at the start of the twentieth century?

Rosemary: Well, the usual route would be to train through a hospital and then it was actually there were lots of opportunities to work as private nurses either hired out by the hospital or through nursing associations or agencies.

Caroline: This is Dr Rosemary Cresswell, senior lecturer in global history at the University of Hull. She has researched the history of nursing and first aid extensively, and is currently working on a history of the British Red Cross. If you’ve listened to the very first episode of this podcast, about surplus women, then you might recognise her voice, because she was one of my very first guests. Lovely to have her back again.

Being a nurse in 1910, say, didn’t necessarily mean that you would work in a hospital, though, even if that’s where you did your initial training.

Rosemary: Three or four years and three would be the normal I think by that time. Nightingale School is training for four years, that’s at St Thomas’s Hospital. It’s a serious training, you’d be expected to get experience in a variety of wards and types  of care. Whereas prior to Nightingale’s time you might have just been working with a particular doctor on a particular wards. You’d only know particular skills. So the training is very different by the early 20th century.

Caroline: The National Health Service in Britain wasn’t founded until after the Second World War, and in the couple of decades prior to that access to free healthcare was still extremely patchy. Wealthy people paid for their treatment privately and tended to prefer to be seen by their doctor at home, away from the risk of infection in public hospitals. But although medicine was changing at this time, there was still plenty of work for nurses in private practice within households.

Rosemary: This is in that period when the middle and upper classes are starting to go into hospital. Before that, they’ve tried to avoid being in hospital. They’ve been treated in their homes. So there’s still quite a lot of work in people’s homes. There’s also kind of increasing amount of nurses working in nursing homes as well. Convalescent homes. It’s a lot to do with the kind of aseptic care in hospitals from that time, it’s a lot more sanitary to be operated on, for example, in a hospital. But there’s still examples I’ve looked at myself in my own research of nurses being at least questioned in exams on carrying out surgery in the home into the 1930s. So it’s a period of transition, still, whether the wealthier classes are going to go into hospital or trying to be treated at home.

Caroline: Readers of detective fiction set around this time will be quite familiar with the nurse who is hired to live within a middle or upper class household to provide treatment to someone who is sick. Think of Unnatural Death by Dorothy L. Sayers, for instance, where elderly cancer patient Miss Dawson is tended to by a combination of the live-in professional nurse and her own niece, who also has professional training. Or of Sad Cypress by Agatha Christie, where Nurse O’Brien looks after Mrs Welman in her own home after she’s had a stroke. Or there’s The Blue Geranium, a story from the first Miss Marple collection, The Thirteen Problems, in which the invalid Mrs Prichard is looked after by a succession of private nurses, many of whom suspect that their patient doesn’t really have any physical ailments but rather only mental ones. Since detective stories quite often revolve around a crisis of health for one or more characters — either because of an attack of some kind like a poisoning or because there a natural death is imminent that will kick off a question of inheritance — nurses are regular presence.

At a time when it was by no means the norm that women worked outside the home, nursing was a vocation that was deemed socially acceptable even for well off young women to adopt. All the work that Florence Nightingale and her Victorian contemporaries had done to establish nursing as being about sanitary care and wellbeing had paid off, because the role of the nurse had acquired a sense of virtue and respectability. Still, as Rosemary says, it’s not as if debutants were flooding the wards all at once.

Rosemary: It’s obviously people who need employment and the intention from Nightingale’s time is to get a better educated class of women and to enter hospitals and training. But it’s still obviously it’s women who need to go out to work who are often training.

Caroline: Nurses were still by and large women who needed to earn their living. But as with many of the topics I cover on this podcast, the onset of the First World War was to completely change nursing as a profession. The huge loss of life on the battlefields of France created a massive demand for medical personnel, both in field hospitals and back in the UK as wounded soldiers were transported home for treatment and convalescence. Here’s Rosemary again to explain how this changed the way nurses thought about themselves:

Rosemary: There’s been a lot of discussion because of the First World War, and so the voluntary aid detachment members who had a much briefer training, although they’ve had considerable experience of work during the First World War. So by 1918-19, nurses really wanted to express that they’re a profession, they’d been trained thoroughly and they have a register for nurses by 1919. So this means that’s. So there’s a real identity for nurses I think by the 1920s that they’ve been trained, they’re professional, they want to set themselves apart from people who haven’t been. And there’s still lots of different ways you can go into heath care. There’s things like health visiting, you don’t necessarily have to have a nursing background for that. So these professions are starting to have that training identity very specifically, which I think midwifery’s had from 1902, so nursing is a little bit behind that because of all the debates about how do you say who’s a trained nurse.

Caroline: When we first meet Tuppence in Agatha Christie’s The Secret Adversary from 1922, she has just been discharged from her role in the Voluntary Aid Detachment. Among other things, as a VAD she had worked in a hospital as an auxiliary to the nursing staff (mopping floors, peeling potatoes and referring fights between Matrons about boiled eggs, as she memorably describes in the novel’s first scene). She clings to her job “like a limpet” for months after the Armistice, but is eventually dispensed with as the hospital goes back to a peacetime footing, a dismissal that ultimately plunges her into the mystery that makes up most of the book. Even though Tuppence doesn’t make a career as a nurse, her years working as a hospital ward maid had a great influence over the rest of her life — just like Christie’s own time as a VAD dispenser at the hospital in Torquay that I covered a couple of episodes back.

Nursing, whether as a professional engaged in a private capacity, or as a volunteer during the war, was an important shared experience for many of the women who lived through the first world war. After the Armistice in 1918 and the flowering of detective fiction that followed, it makes sense that the nurse as a character was present in plenty of those stories.

After the break: how are you feeling today?

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The nurse is such a useful character to the detective novelist. The role comes with connotations of all that is nurturing, compassionate and womanly, which can either make her a foil for evil elements elsewhere in the story, or provide a handy facade for a murderer in need of a disguise. The classic uniform of a nurse in the early twentieth century, with its folded and starched white cape covering the hair and some of the face, can make her an anonymous figure — did a witness really see a nurse they knew, or just someone else wearing the same outfit? And on top of these outer characteristics, her training gives the nurse a command of detail and plenty of experience in reading people.

The private nurse working within a middle class household also occupies a strange position, neither quite one of the family nor one of the servants. Like a governess or companion, she inhabits a liminal space in which her education and training command respect, but she’s still a working woman who is paid to be there rather than an invited guest or an equal. As such, she can observe moments from which a housemaid would automatically be excluded, and access parts of the house at odd times of the night under the cover of fulfilling her duties.

Now, I won’t spoil the plots of any of the stories that I’m about to mention, but I’m sure you can see from what I’ve outlined there how a nurse is perfectly equipped both to commit a clever murder, and to be the detective that uncovers such a plot. Detective novelists have used this archetypal character both ways with both success, and although I’m not going to reveal any solutions, I just want you to keep in mind that these characteristics cut both ways.

The nurse as detective has a distinguished pedigree, beginning with Grant Allen’s Hilda Wade from 1899. She’s a brilliant sleuth who solves medical mysteries with the help of her almost supernatural-seeming intuition (although as my guest laid out in the Victorian Pioneers episode of this podcast, what seems supernatural in a woman is considered just natural intelligence in a man like Sherlock Holmes). Allen actually died before fully finishing Hilda Wade, having dictated the final scenes from his death bed to his friend Arthur Conan Doyle, who polished it up before publication. As Rosemary explained earlier, Hilda Wade is working at a time when nursing isn’t quite yet a formally recognised profession, and there is also a sense with that character that if it was easier for a woman to become a doctor, she would be doing that instead. Still, it’s a great book and I highly recommend Hilda Wade as the matriarch of all the nurse sleuths who followed.

The writer Mary Roberts Rinehart, sometimes called “the American Agatha Christie”, trained as a nurse in Pittsburgh herself, graduating in 1896. She married a doctor and worked with him on surgical cases until financial hardship forced her to take up writing as well for an extra source of income. Unsurprisingly, she drew on her own professional experience for plenty of her books, and one of her most memorable creations is the private detective Hilda Adams, also known as Miss Pinkerton. A trained nurse, Adams is recruited in the first story, 1911’s The Buckled Bag, by one of her patients, who is a police detective. He is impressed by her competence and discretion, and of course quickly grasps the potential of having a detective who is also a nurse and can use her dual role to gather evidence for tricky cases. And it works — in the five Hilda Adams stories, she uses that ambiguous role of private nurse in a well to do household to gather clues and crack tough cases.

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As the golden age took over from the more swashbuckling, Holmes-esque stories of the late Victorian detectives, the nurses become more nuanced and ambiguous characters. Dorothy L. Sayers worked very successfully with this in 1927’s Unnatural Death. In this book, Mary Whittaker, a highly competent nurse who gave up her post in a London hospital to move down to the country and care for her ageing aunt, faces off against sleuth Lord Peter Wimsey. He is investigating the suspicions voiced by Whittaker’s local doctor, who believes that despite appearances, the aunt did not die of natural causes (hence the novel’s title). Wimsey has a healthy respect for Whittaker’s intelligence and ingenuity, and Sayers plays nicely on that dual interpretation of a nurse’s skills — she could equally either be the wrongfully accused healer, or the cunning murderer.

There’s a nurse in Sayers’s 1930 novel Strong Poison too, who plays a minor but pivotal role. Miss Booth is a retired nurse who works in a private capacity caring for a wealthy but ailing elderly stage actress. This latter lady’s will is crucial to Wimsey’s investigation, and he dispatches Miss Climpson, the head of his “surplus women” investigative bureau, to find out everything she can about it. I talked more about the relationship that Misses Climpson and Booth strike up in the episode about spiritualism — because it is over a seance that they bond — but those scenes are a great example of how the presence of a private nurse can provide a detective with a way into a household that they otherwise have no business snooping around in.

Jumping forward a decade and a bit for a minute, a very similar plot device applies to Anthony Gilbert’s 1945 novel Don’t Open the Door, which was published in the US under the in my opinion better title of Death Lifts the Latch. Gilbert, by the way, was one of the pseudonyms used by the extremely prolific British mystery writer Lucy Malleson — I want to make a whole episode about her so I won’t get too into her biography here. Suffice it to say that she wrote a lot of mystery novels between 1925 and her death in 1974, and most of them have now quite unjustly disappeared out of print. Don’t Open the Door opens with a nurse, Nora Deane, making her way to her next private client through the fog. A man’s friendly voice guides her to her destination, but vanishes when she reaches the right doorstep. Nurse Deane’s patient then dies in the night, and later she herself disappears. Gilbert’s regular detective, the lawyer Arthur Crook, then enters and investigates all of these strange goings-on. In this story, the nurse is a witness and a potential victim, rather than a detective herself, but the story is no less enjoyable for that.

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Beyond the world of private nurses, there are a couple of notable examples where the nurse in a whodunnit is a district nurse responsible for caring for patients in a rural area. I already mentioned Sad Cypress by Agatha Christie from 1940, which features Nurse Hopkins — a well known figure in the local community where the death of an elderly lady has recently taken place. She’s one of the people present during a tea party that the results in the novel’s second death, and her evidence about some medical terminology is ultimately key to Poirot cracking the case. Later, the 1955 novel Scales of Justice by Ngaio Marsh uses the observations of District Nurse Kettle to frame the whole narrative. The story opens with her pen portrait of the village of Swevenings and its inhabitants, and ultimately closes with a similar recollection — with crucial updates after the events of the whodunnit have unfolded. Class is one of the big themes in this story, but the nurse moves easily between different households and can therefore see more of what goes on than an ordinary character would.

As I’ve talked about before, institutions like schools with regular timetables and routines work very well as settings for murder mysteries, and the same goes for medical establishments like hospitals, clinics and nursing homes. Marsh actually wrote a novel entirely around the latter premise, called unsurprisingly enough, The Nursing Home Murder. It was her third book, published in 1935, and sees her sleuth Roderick Alleyn investigate a case of what we might now call medical malpractice. A British MP is taken ill with appendicitis while speaking in the House of Commons and rushed to a nursing home for treatment. He dies shortly after the operation and his wife becomes convinced that someone used the appendectomy to kill her husband in a plausible and hard to detect manner. The surgical team, which includes several doctors and nurses, all come under scrutiny as potential suspects and their special roles in the operating theatre are examined for their potential for murder. As a closed circle story with lots of period medical details, this one can’t be beat, I think.

It’s also worth mention the Cherry Ames books, beginning with Cherry Ames, Student Nurse by Helen Wells, which was published in 1943. This is a really popular American mystery series in Cherry, a sleuth rather in the Nancy Drew mould, solves mysteries in the hospital she works in. They’re not really golden age and are more of a crossover with the kind of girls’ fiction popular in the 1940s, but they are still lots of fun and a good illustration of why the hospital setting can work well for mystery plots.

Christianna Brand’s Green for Danger shares some plot similarities with Marsh’s novel, although her story is set in a hospital during the second world war. Brand, by the way, also wrote the Nurse Matilda books that were subsequently adapted as the Nanny McPhee films. In Green for Danger, a nurse is the first murder victim after she blew the whistle on a dodgy operation during which the patient died. Like Alleyn, Brand’s sleuth Inspector Cockrill ultimately has to stage a recreation of the surgery to help get to the bottom of the mystery, so that he can see the hospital’s procedures in action and spot where the gaps are that the murderer has exploited.

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The more I’ve thought about nurses in detective fiction, though the more I come back to the double-edged nature of their role. All medicine relies on trust, because the patient must trust that those treating them are trying to help not harm. We put our faith in science, and those who have spent their professional lives delivering care. But in the context of a murder mystery, though, you can never be quite sure. Is the smiling, sympathetic young woman in the pristine white cap going to use her skills to save your life, or to bring it to an untimely end?

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This episode of Shedunnit was written, narrated, and produced by me, Caroline Crampton. You can find show notes at shedunnitshow.com/bedsidemanner where there will also be links to all the books and sources I mentioned. I provide transcripts for every episode of the podcast too: find them at shedunnitshow.com/transcripts

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I’ll be back on 13 May with another episode.