1. Representations and Practices of Nursing
Medicine, Disease and Society in Britain,
Representations and Practices of Nursing
Lecture 12

2. Lecture Themes and Outline
Changing representations and practices of nursing
Situation up to the ‘Reforms’ of the C19.
Reform : Nightingale
Modernisation
Professionalisation- Registration and the creation of state nursing
2. Perceptions of women’s roles
3. Women doctors

3. Definition of Nursing
Attending to the needs of permanently or temporarily disabled patient; administering food and drink as well as medicaments; keeping patient comfortable; keeping the patient and his surroundings clean; ensuring the patient is treated as the subject as well as the object of treatment and helped to keep quiet, calm and cheerful; medical observations, by eye or instrument, of physical or behavioural reactions to diet and therapy: the patient must be nursed for as long as the illness continues, regardless of outcome.
(Anne Summers, from Loudon, Western Medicine)

4. Points to consider Emphasis on care rather than cure
Nature of the work - is it specialist or akin to domestic work?(She) is seen as necessary to the success of scientific diagnostic medicine as well as domestic health care.
Nursing requires not only learned skills but qualities of character – contentious?
From the late C19 onwards nursing becomes increasingly a paid and professional occupation, but retains ideas of service. Continued religious link.
Associated with women - traditional carers of children and the sick, associated with selflessness and subordination.

5. Nursing in the C19th
‘Since the nineteenth century, nursing has sought respectability and modernity by linking its fortunes firmly with mainstream medicine, and by seeking a secular model for the profession to distance it definitively from its religious, unscientific past’.
(Anne Summers, from Loudon, Western Medicine)

6. Sarah/Sairey Gamp, Dickens’s fictional character, was used by the growing nursing profession of the nineteenth century to blacken the reputation of the working nurse who had provided a service in home and hospital without the benefit of ‘modern’ training.

7. Circa 1800s:
The Monthly Nurse
A 'nurse' employed to care for the woman of the house during the 'monthly cycle‘ or after childbirth.

8. Nursing duties at the London Hospital, c. 1740
‘To enter upon their Business every morning at six in Summer and at seven in Winter, to stop at ten and be in bed by eleven every Night; to clean their wards, pewter and utensils every day by seven in the morning; to attend the patients diligently during their Watch, and provide them with what is directed by the Physician, Surgeon and Apothecary, and see particularly that they take their medicines, and to keep the beds of the Patients neat and decent.’

9. 3 distinct phases in professionalisation of nursing (Maxine Rhodes)
1. Nursing was split off from domestic care and became a respectable occupation for middle-class and poorer women.
2. Nurses began to develop a recognized body of skills, taught in nursing schools.
3. A system of registration was created which established common standards of training for all qualified nurses.

10. 1879
An intoxicated nurse; the cartoon implies that nursing had improved as the text reads The nurse - old style; giving the impression that nursing moved forwards from this date. 10

11. Florence Nightingale, founder of modern secular nursing (1820-1910)
Notes on Nursing (1860)
Health, sanitarian believed in miasma
Set up training school for nurses at St Thomas’ Hospital, London
Character as important as technical skills
Deeply religious but her character was far removed from the sentimental Victorian imagery of the ‘Lady with the Lamp’ and the ‘angel of mercy’.

12. Nightingale Myth
‘It was not until the great Florence Nightingale returned in glory from the Crimean War, in the year 1855, that steps were taken to train nurses systematically for a period of years, after which they could work independently as professional nurses. Money publicly subscribed to Florence Nightingale for her wonderful work in the Crimean War was used by her to found the Nightingale School for Nurses at St Thomas’s Hospital. These Nightingale nurses went to the ends of the earth founding nurse-training schools, after the pattern of their alma mater in London.’
Nursing as a Career and Livelihood, G M Hardy (1955)

13. Circa 1850:
Florence Nightingale as a Nightingale with her angels caring for the wounded in an illustration titled ‘Wounded Soldiers and Nightingales’.

14. Nurses’ Experiences
“Very little was expected from us, as progress was slow in regard to organized teaching. Kindness, watchfulness, cleanliness, and guarding against bed sores were well ingrained. A few stray lectures were given…There was a dummy on which to practice bandaging, and some lessons were given, also a skeleton, and some ancient medical books, one, fortunately, on Anatomy for those who attempted self-education.”
Rebecca Strong, 1867, quoted in Anne Summers, Angela and Citizens: British Women as Military Nurses, , (London: Routledge and Kegan Paul, 1988), p. 93

15. Typical Nurse’s Experience, c. 1890
“The nurse went on duty at 7.00am. Much of the work consisted of washing patients, cleaning wards and medical equipment, food preparation and serving (including carrying round brandies and wines for patients), some tuition, 2 daily prayers. Bed at 9.20 with very short breaks for meals.” Joan Lane, Social History of Medicine

16. Campaign for Registration
Began 1880s
1888 – British Nurses Association formed
1899 – International Council of Nurses founded
– War raised nurses’ status
1919 – Nurses Registration Act
1941 – National pay scales

17. Late 19th century campaign for women’s suffrage.

18. Aims of Registration
To set up centralised means of control over nursing- a central body or council of nurses
Self-government- so nurses should have a majority and direct representation on the council
A one-portal system of entry- control over the curriculum an duration and standard of training and a single register

19. Opposition to Registration
The Voluntary Hospital sector who controlled pay and conditions. They wanted Nightingale’s model of the nurse as a devoted, disciplined, cheap and complaint, work force, and not an upper class. Matrons also opposed, under the current system they had an enhanced managerial role and feared registration would lead to centralisation and they would lose local control over nurses.
From the medical profession- although this was mixed- had many supporters, including from husband of Bedford-Fenwick.
From nurses who were anti-registration- including Florence Nightingale.

20. Coventry Patmore, (1823-1896) The Angel in the House (London: John W
Coventry Patmore, ( ) The Angel in the House (London: John W. Parker and Son, 1854) This four-part domestic epic celebrating married love as the highest form of love between a man and a woman was published over eight years, from Though critics disparaged its saccharine sentimentality, it was a great favourite with the reading public in the late C19. Perhaps more known than read, the poem contributed to Victorian rhetoric about a woman's proper role and the cult of domesticity.

21. Anne Witz, Professions and Patriarchy:
“The passage of the Nurses Registration Act in 1919 did not represent a victory for pro-reigistrationist nurses. The nursing profession had not come to power. Instead nurses were henceforth to be tightly constrained within a state-profession relation within which they were the weaker partner, as well as within the employment relation between hospitals and nurses and the inter-professional relation between doctors and nurses.”

22. The following passage comes from an account in the Lancet of Elizabeth Garrett Anderson’s first year as a student:
“The advanced guard of the Amazonian army which has so often threatened our ranks, on paper, has already carried the outposts and entered the camp.”
The Lancet, 6 July 1861, p. 16

23. Elizabeth Blackwell (1821-1910)
1858- entered on the Medical Register by virtue of holding a foreign medical degree. This ‘loophole' was closed.

24. Elizabeth Garrett Anderson (1836-1917)
Gained licence from Society of Apothecaries.
They moved to refuse to examine candidates who had not studied at a recognised medical school

25. “Men have little idea how much prolonged and increased suffering is often borne by their mothers, wives, sisters and daughters, just because they have not been able to consult physicians of their own sex. Nay, death itself has often prematurely cut down women, whose reluctance to seek advice from a man was only overcome by extreme pain when it was too late.”
From a letter to The Scotsman, 29 December 1872, entitled ‘A Woman on Women Doctors’.

26. Sophia Louisa Jex-Blake (1840–1912).
1869 Campaigned at Edinburgh University
Qualified in Berne, licensed in Ireland
1874 Helped to establish London School of Medicine for Women
1886 established Edinburgh School of Medicine for Women

27. Number of women doctors in England and Wales:
25 or 0.17% or 2%

28. Conclusion Three themes in the development of modern nursing emerge:
The impact of reformers and pressure groups – Who? What?
The role of the state
The changing experience of women in society – private/public spheres