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Charlotte Seymour Yapp
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Chatterton, Claire and Wade, Lesley (2013). Charlotte Seymour Yapp. The Bulletin of the UK Association for the History of Nursing, 2 pp. 49–51.
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Copyright and Moral Rights for the articles on this site are retained by the individual authors and/or other copyright owners. For more information on Open Research Online’s data policy on reuse of materials please consult the policies page. oro.open.ac.uk THE BULLETIN Of the UK Association for the History of Nursing
Volume 2 November 2013
The UK Association for the History of Nursing (UKAHN) is a network of scholars in the field of Nursing History. It is supported by the School of Nursing, Midwifery and Social Work at the University of Manchester UK
Please contact the Editor to submit material or to discuss future contributions:- Jane.Brooks@manchester. ac.uk Emily Soper © “ going on night duty 66th Indian General Hospital, Manipur Road, North Assam 1945-46”
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UK Association for the History of Nursing Bulletin 2013
Jane Brooks Editorial
Original articles Myra Valley Recruiting ‘agents of empire’: The social backgrounds of the Scottish women of the Colonial and Overseas Nursing Associations, 1899-1939
Olivia Fiorilli Public health nursing in Italy, a postcolonial perspective
Sarah-Jane Liva, Geertje Labour support and high-touch care: A lost art in perinatal nursing? Boschma & Wendy Hall
Charlotte Dale ‘She dined once at Major Bagot’s with us, has an 18 inch waist, scarlet belt and makes up’: The social exploits and behaviour of nurses during the Anglo-Boer War 1899 – 1902
Claire Chatterton ‘An unsuitable job for a woman?’ Gender and mental health nursing Biographies Claire Chatterton Charlotte Seymour Yapp Lesley Wade Obituary Claire Chatterton Lesley Wade (1955-2013) Nurse historian and lecturer
Reports on events and articles of general interest Angela L. Turner-Wilson, Sarah Keeley, Festival of Learning showcases the History of Petra Brown, Gill Jordan & Cate Wood Nursing
Alison O’Donnell ‘Colonial and post–colonial nursing’: History Of Nursing Colloquium 2013
Janet Hargreaves An Accidental historian
Carolyn Gibbon Hotel Dieu, Beaune Dates for your diary UK Centre for the History of Nursing and Seminar Series 2013-2014 Midwifery (UKCHNM)
UK Association for the History of Nursing Colloquium 2014 (UKAHN)
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Editorial Jane Brooks, University of Manchester
Welcome to the third Bulletin of the UK I turn therefore to the Mid- Association for the History of Nursing, and Staffordshire Hospital Inquiry and reflect my first as editor. I do feel some sense of at this time on the continuing poor trepidation following on from John leadership and interest placed on the care Adams, who is an experienced editor, of older people. But perhaps the whereas I am a mere neophyte. I do hope problems have now extended beyond this however, that you all find the contents ‘Cinderella service’ to hospital and interesting and thought provoking. We community care for all types of people have been very lucky receive excellent and patients. As a nurse I am saddened manuscripts from colleagues all over the that patients should suffer, as a historian globe; it is, I feel a truly international of nursing it is important to acknowledge volume. these problems are not new, its 2013 has been a difficult and sad antecedents reach far into the past of our year for nurses in the UK and for those of health services. And it is this I think that us involved in the history of nursing. The makes the history of nursing such a vital death of Lesley Wade, nurse, colleague part of nursing now. It is not enough to and historian was one which touched us blame the current cuts, current nursing all. Moreover, her loss is not only to the education, current hospital structures for history of nursing, but also those involved problems in the health service, because in the care of older people. Lesley’s this is not the first time that our country championing of this all too important area has faced scandals of poor care in its of nursing that had suffered poor status hospitals. I hope that through studying the and often deplorable staffing levels was history of nursing, scholars can help to influential to many of us who were offer thoughtful debate on these difficult involved in the care of older people in the issues. 1990s. My own oral history research on May I take this opportunity to the care of older people in the mid- thank you all for your support of the UK twentieth century, highlighted many of Association for the History of Nursing over the problems which Lesley endeavoured the past three years. to fight against - poor status, low staffing I should also wish to remind readers that levels, a poverty of leadership and inertia postgraduate research studies are offered from within. The publication of Sans by all the universities represented by the Everything in 1967, the Whittingham Association’s Committee members. If you Hospital Enquiry in 1972, alerted the are interested in pursuing a postgraduate population at large to the problems faced degree, please do go to the UKAHN by not only older adult, but also mental Committee page and contact the health services. And yet, against all of this members for advice. Lesley demonstrated to all the vitality of caring for older people.
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Recruiting ‘Agents Of Empire’: The Social Backgrounds of the Scottish Women of the Colonial and Overseas Nursing Associations, 1899-1939
Myra L. Valley, independent scholar principally associated with McMaster University in Hamilton, Ontario.
‘Thaim wi a guid Scots tongue in their heid are fit tae gang ower the warld’.1
Miss Agnes Ramsay of Glasgow, aged 34, consideration of the level of education, came to the London headquarters of the and work experience before nurse Colonial Nursing Association in 1899 to be training, in order to gain an understanding interviewed for a nursing position within of the Scottish women who joined the the Empire. Ramsay sailed on December CNA/ONA. It is apparent that the 4, 1899 for Ceylon where she served as CNA/ONA was viewed by many Scottish Lady Superintendent of the Hatton nurses as a potential career growth Nursing Home until she was invalided out opportunity through which they could see in 1902. Miss Ramsay had trained at the the world, and contribute to their Glasgow Western Infirmary for three profession abroad. The destinations of years. She had worked at the Lanarkshire these nurses were varied, spread Isolation Hospital for eight months, served throughout the formal British Empire and as a district nurse for fifteen months, and the zones of economic penetration had been Superintendent of the Dover beyond it. These nurses were necessarily Union Infirmary ‘for some months’ prior a part of British imperialism. A full to applying for a nursing position abroad.2 comprehension and assessment of these Miss Ramsay was one of the first three nurses as ‘agents of empire’ – both Scottish nurses to be recruited for consciously and as part of the intricate overseas service by the Colonial Nursing systems of colonization – requires a Association, established in 1896. In total ‘cradle to termination of overseas the Colonial Nursing Association (CNA) contract’ approach.4 Who were they? recruited 106 Scottish nurses before it Where were they educated and trained? became, in 1919, the Overseas Nursing What prior nursing experience did they Association (ONA). By December, 1939, possess, abroad, in the British Isles, or at this latter body recruited a further 389 home? The present study establishes the Scottish nurses. parameters of the investigation as a This article is part of a wider study which whole, and examines the geographical explores the lives, careers, and personal and social origins of the Scottish sentiments of these 495 Scottish women CNA/ONA nurses. who nursed abroad between1899-1939, This study demonstrates that there was under the auspices of the CNA or ONA.3 not a single type of Scottish ‘colonial’ or This study includes an analysis of the lives ‘overseas’ nurse and suggests that ‘simple and work of these nurses up to the stereotypes’ of the British-trained nurse termination of their involvement with the abroad are unhelpful.5 The nurses were CNA/ONA. The variables to be examined remarkably diverse in their geographic include birth place, place of residence at and social origins; they experienced a time of application, parental occupation, wide range of pre-training and post- religion, ages at time of training and training nursing employments; they application to CNA/ONA, some utilized the CNA/ONA for exceptionally
4 brief, or very lengthy, career the formal and informal British zones of opportunities, as befit their individual world influence, but also, less directly, the preferences and requirements. The one global flow of economic resources into feature shared by almost all was the British Isles.10 Overall, we may utilize migration: from birthplace to training these Scottish nurses to consider another centre, to war service, to diverse outcome of ‘the drive to professionalize’ employments, to the CNA/ONA. A within late nineteenth and early twentieth significant proportion had left their native century British nursing.11 Scotland well before application to nurse Professionalization made these CNA/ONA overseas. The Secretary of State for the Scottish nurses marketable throughout Colonies in 1912 termed them the the English-speaking world. The ‘British- “ministering angels of Empire”.6 In 1900, trained nurse’ was the standard, both for Mrs. Mary Chamberlain, one of the overseas care and for the training of founding members of the CNA, praised ‘so colonized peoples. Without prior U.K. many highly qualified women’ who were professionalization (and ongoing ‘ready and eager’ to serve with ‘unselfish specialization) the characteristics and devotion’.7 It is arguable however, that cultural meanings of British colonial and these nurses were neither angels nor overseas nursing would have been very unrealistically unselfish. They were a different indeed. highly trained workforce who seized an The Context available opportunity. As skilled workers, Scotland, one of the most literate nations they were seeking to maximize in Europe as a result of the eighteenth opportunities not simply in terms of pay, century Enlightenment, played a but in experiences and lifestyle as well. significant role through the nineteenth Nurse migration is an important and twentieth centuries in the thorough component of historiography, and this and systematic colonization of all areas of present study offers a contribution the British Empire, including commerce, through systematic investigation of one administration, military, colonial ethnic group in its antecedents, skill education and medicine.12 As a result, development and pathway. Scots were often positively received when It is now 25 years since Christopher Maggs they emigrated to different parts of the wrote about the peculiarities of the late world. The exports of the Scottish nineteenth century ‘which included diaspora involved talent, intellectual economic, political and social expansion capacity, and technology, and its by the industrialized nations of Europe population was well represented within and America,’ and gave rise to the specific the fields of British and imperial medicine, characteristics of twentieth-century nursing, and health care. The processes of nursing.8 As will be demonstrated, the 495 change, migration and emigration were Scottish nurses under study were created clearly evident in developments within within the new British socio-economic the field of nursing and, with this, the system, but Maggs’ statement possesses Scottish nurse. more relevance than this. As pointed out The image of nursing as a profession in by Diana Solano and Anne Marie Rafferty, Great Britain underwent dramatic the CNA/ONA nurses benefited from a evolution in the second half of the ‘globalising healthcare market’.9 Overseas nineteenth century. The Annual Report of nurse recruitment and migration reflected the City of Glasgow Fever Hospital for ‘the global flow’ of human resources into 1865-6 captured the long-standing
5 negative conception of nursing as ‘... the appraised, and recommended for specific last resource of female adversity. overseas postings by the CNA; by 1909 the Slatternly widows, runaway wives, total stood at 467.18 The CNA/ONA quickly servants out of place, women bankrupt of became recognized as the source from fame or fortune – fall back on hospital which the Colonial Office acquired its nursing’.13 By the close of the nineteenth principal supply of nurses for government century, the image, the training and the work in the Crown colonies.19 Prior to duties of the British nurse had altered in World War II, the period under study, the significant and fundamental ways, Colonial Office always maintained an influenced in part by the work and arm’s length working relationship with the prominence of Florence Nightingale. CNA/ONA.20 In 1940 the Colonial Office Nursing as an occupation, however, had formalized its direct involvement in not yet acquired either a unique body of overseas nurse recruitment by knowledge or an established skills base.14 establishing the Colonial Nursing Over this same time frame, nursing was Service.21 Instead of the colonies running also affected by social change: in their own individual or regional nursing particular, the widening of the differential structures, the result was a unified between hospital-trained nurses and service. Administrative processes and servants.15 Additionally, shifts in public policies were introduced to promote attitudes brought about by the experience increased mobility for British nurses to of nursing during the first World War and take up, and transfer between, posts by the higher proportion of women across the Empire. However, the Colonial engaged in gainful employment, impacted Secretary stated at the time that positively the changing face of nursing.16 ‘applications for appointment as Nursing The establishment of the Colonial Nursing Sisters in the Colonies continue to be Association helped provide an impetus in dealt with by the Overseas Nursing the development of overseas nursing as a Association and candidates are career choice for nurses. Organized in recommended by them’.22 From 1896 1896 by a small group of socially until the Colonial Nursing Service was prominent British women in London, the disbanded in 1966, the CNA/ONA CNA was self-funded by voluntary recruited a total of 8400 British-trained contributions. Its chief concern in the nurses for employment overseas.23 To initial stages was the lack of nursing date, published studies of CNA/ONA facilities available for British expatriates nurses are in their infancy, albeit living overseas. British-trained nurses illuminating and thought-provoking. were to be dispatched to men and women Overseas nursing was touted in 1936 by ‘whose duties and avocations lead them Lady Edith Antrobus, Dame of the British year by year to these faraway tropical and Empire and Honorary Secretary of the often unhealthy climates’.17 The CNA/ONA ONA as ‘the Plum of the Profession’ worked to recruit qualified nurses both requiring very special qualifications and a for government service in the Crown high level of adaptability on the part of colonies and as private nurses to small the nurse.24 These individuals were the English communities in foreign territories public, and the private, face of the British- where British inhabitants had formed trained nurse in the wider world. This local support committees. Between 1896 evoked both pride, and anxiety. and the end of 1903, 167 successful Most CNA/ONA recruits were English, but British applicants had been interviewed, from the first decade of service there
6 were also sizable numbers of applicants for Scottish candidates were significantly from Ireland, Wales and Scotland. The higher than for CNA/ONA applicants first eleven Scottish nurses sent to overall. An internal committee of inquiry postings overseas by the CNA in the of 1910 determined that ‘not more than period from 1899 to 1902 were one-third of those interviewed are found, interviewed and processed at the London apart from their technical qualifications, headquarters at the Imperial Institute in to possess the personal attributes which South Kensington. However, for improved the Committee consider necessary’.27 recruitment of future nurses, a Scottish Overall, the approximately 6300 total branch of the CNA was envisioned as early interviews by CNA/ONA between 1896 as 1900. The minutes of a CNA meeting of and 1939 led to approximately 3904 April 24, 1900 included an appeal for help nurses serving overseas.28 In round in inspiring and recruiting nurses for numbers, the success rate for all service abroad, ‘especially to Scotsmen, applicants was 62%; for Scottish the bond between Scotland and the applicants it was 77%. The principal Colonies being a very close and strong reasons cited in CNA/ONA records for one’.25 The Second Annual Report of the failure to obtain an overseas position Scottish branch stated that the work of included lack of candidates’ appropriate the Association had finally been started qualifications, and the applicants’ own throughout Scotland, having been delayed decisions to withdraw from the process by fund-raising efforts and attention for personal or professional reasons. As devoted to the war in South Africa.26 well, some applicants were deemed to be While the applications continued to be ‘unsuitable’ by the Recruitment submitted to the London office, Committee, due to factors such as being interviews were conducted by the Scottish over the prescribed age limit, failure in Committee in Edinburgh. This Committee the mandatory medical examination, or forwarded its recommendations to the perception by the Committee headquarters, which in turn arranged the members that the nurse was ‘unlady-like’. placements with the Colonial Office or Such candidates were rejected. In a large with overseas committees. The number of cases, no comment was headquarters’ staff also provided entered in the extant records as to why mentoring and support for the nurses in candidates did not proceed to overseas the field. The Scottish Committee was postings.29 unique; all applications from Ireland, The Archival Sources Wales, the dominions or elsewhere were For purposes of this and subsequent administered at the English headquarters. studies, data was gathered from the Between 1896 and 1939, the CNA/ONA CNA/ONA Registers of Nurses, and other interviewed approximately 6300 nurses sources, for all 495 Scottish nurses who for positions overseas, with Scottish were successfully interviewed and nurses comprising approximately 10% of subsequently sent abroad, 1899-1939.29 this total. Over the four decades under This includes those nurses who review, this percentage varied from a low interviewed in London, but were of 7.4% in the 1900-1909 period, to a high designated in the ONA Registers as of 15.7% for 1920-29. Approximately 23% ‘Scottish candidates’. In addition to the of the total number of Scottish candidates information contained in the registers, interviewed did not proceed to an original completed application forms for overseas posting although success rates 47 of these Scottish nurses are at present
7 extant in the CNA/ONA archives; these Although valuable studies have been provide more extensive information on made of the history of nursing, the history this smaller sub-set.30 Only four of some of the more prominent hospitals completed application forms exist for the in both England and Scotland,32 and of period up to 1919; the remainder date various aspects of health care and nursing from the 1920s and 1930s. For this education in the United Kingdom, the investigation, the total group of 495 general lack of a detailed examination of nurses will be referred to as the Study Scottish nurses, as a distinct component Group; the smaller sub-group of 47 will be within the British profession, circa 1899 – referred to as the Cohort. 1939, means it is impossible to make, at Relevant information was also obtained present, exact comparisons of the socio- from the nursing training registers of the professional characteristics of the 495 Glasgow Royal Infirmary, the Western CNA/ONA nurses to the far larger body of Infirmary of Glasgow, and the Royal Scottish nurses for this era. Nonetheless, Infirmary of Edinburgh.31 The Glasgow this present study possesses significance Royal Infirmary registers provided, for in appraising one sub-set of Scottish some trainee nurses, information on dates nurses – the ones who went on to devote of training, age at entry, occupation at least a portion of their careers to before training, and, for the entries in the overseas nursing through the CNA/ONA. 1930s, courses taken and grades As there has been limited research on the obtained. The Western Infirmary of British CNA/ONA nurses, as a group or Glasgow training records indicated dates cohort, it is not feasible at present to of training, age at admission, religion, demonstrate how Scottish nurses, in their courses completed, including number of social backgrounds, education, and months spent in each specialty and grades experiences, may have been typical, or obtained, general performance comments atypical, of the much larger body of and reasons for leaving. The Royal CNA/ONA English nurses, or, indeed, the Infirmary of Edinburgh possesses the most Welsh or Irish applicants. For these complete records for each trainee. Data comparative aspects, therefore, this included age at application, dates investigation cannot be definitive. attended, address, marital status, However, the 495 Scottish nurses do occupation before training, comprise a clearly defined, active and comprehensive comments on successful component within British performance, certifications, subjects overseas nursing, with a strong presence taken, time spent on each specific ward within the relevant archives. and reasons for leaving. This Place of Residence/Birthplace comprehensive search in the (sometimes Place of birth is known for the 47 incomplete) records at these three members of the Cohort; place of training institutions uncovered permanent residence at the time of information on 103 of the 495 future interview by the CNA/ONA is known for all CNA/ONA nurses. Finally, research was 495 members of the Study Group. Overall, undertaken at the National Register in the Study Group there was a balanced House in Edinburgh to secure information distribution of candidates between rural on parental occupation at time of birth for and urban areas. This aligns closely with 47 CNA/ONA nurses from the Study the findings in Maria Lorentzon’s study of Group. probationer nurses in England in the period from 1903 to 1912.33Three-
8 quarters of all the urban candidates on the East coast (including possessed permanent addresses (which in Aberdeenshire, Angus, Kincardinshire); most instances meant permanent family 6.9% on the West coast (including Argyll, ties) in one of the three major cities of Bute, Ayrshire and Wigtonshire); 2.3% in Edinburgh, Glasgow or Aberdeen. This the Borders (Dumfries and Galloway, equates to 39.7% of the entire Study Berwickshire). In at least some instances, Group. the permanent addresses in England were Table 1: Permanent Address for Study for Scottish parents who had relocated Group (495 nurses)34 south. Over time, there clearly existed various Urban Scotland 50.9% patterns of geographic recruitment. For Rural Scotland 45.7% example, the relative decline for the East England 3.4% coast shires was matched by a significant increase from the Highlands. The percentage of candidates from Nonetheless, the overall picture is one of smaller cities (those with populations stability: roughly half of the recruitment from 30,000 to 154,000) increased to the CNA/ONA came from the larger and somewhat over the decades, and medium-sized cities, always led by constituted overall 13.9% of the Study between 33% and 44% from Edinburgh, Group, but never rivalled the dominance Glasgow and Aberdeen; the other half of the three urban centres. The remainder arrived at the Association, ready for of the Study Group possessed permanent overseas service and accepted for it, from addresses spread throughout the small across the length and breadth of Scotland. regional centres, towns and villages of To what extent did the geographic Scotland: 16.7% in the ‘waist’ of Scotland diversity of permanent address reflect (including the Edinburgh/Glasgow corridor similar diversities in the places of birth? A 35 plus Perthshire, Stirlingshire, study of the 47 nurses of the Cohort Dumbartonshire, and Kinross-shire ); suggests a similar overall pattern, albeit 10.3% in the Highlands with less representation from the three (Inverness-shire, Moray, Ross-shire); 9.4% major cities.
Table 2: Geographic Distribution of Scottish Permanent Addresses, by Decade of Entry Into CNA/ONA
Decade 1900-09 1910-19 1920-29 1930-39 1900-39 Edinburgh, Glasgow, Aberdeen 42.0% 39.6% 44.0% 33.1% 39.7% Smaller Cities 9.3% 11.3% 11.5% 17.2% 13.9% ‘Waist’of Scotland 23.3% 16.9% 19.4% 20.9% 19.8% East Coast 19.0% 16.9% 7.9% 7.4% 9.9% The Highlands 7.0% 7.5% 10.3% 12.9% 10.8% The Borders 0% 3.8% 2.4% 6.1% 2.4% West Coast 0% 3.8% 4.8% 2.5% 3.4%
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Table 3: Birthplaces for the Cohort (47 Nairnshire. This major shift from rural to nurses) urban locations indicates that migration of nurses to larger Scottish cities, and (for Edinburgh, Glasgow, 43.5%) further afield, had already Aberdeen 21.3% occurred by time of application to the Smaller Cities 25.5% CNA/ONA. Geographic mobility beyond ‘Waist’ of Scotland 14.9% Scotland was already a fact of life for East Coast 7.0% these nurses. This reinforces Maggs’ The Highlands 12.7% demonstration that female migration The Borders 8.5% showed a ‘constant movement’ from rural to urban areas during this period of time, West Coast 0.0% with long-distance migration being
preferentially towards ‘one of the great A comparison for the Cohort of their centres of commerce and industry’.36 places of birth with their stated place of What is perhaps unique for the CNA/ONA permanent address at time of application nurses is that their successful applications reveals that just over one half (52.3%) transported these ‘urbanized’ Scottish specified identical places (with three not nurses to many various locations within indicating permanent addresses on the the Empire and the wider world. application form). For another 34%, Parental Occupation although family had relocated within The occupations of fathers, used as an Scotland, the only emerging pattern indicator of socio-economic background in indicated that no major shift to larger the absence of other methods of urban centres had occurred. One determining social class of entrants37 are, significant development is that several of for the purposes of this investigation, the Cohort nurses (11.4%) had transferred grouped into five categories: agriculture their permanent addresses to England, and fishing; trades and industry; retail and and one had moved to Australia. Of these, service; professional; other (See Appendix none indicated a major city as their new A for details). A sampling of original birth address. records in the National Register Office for The completed application forms also 47 nurses from the Study Group, spread specify the current postal address for the over the decades of study, reveals the Cohort nurses. This was significantly following: approximately 55.3% of fathers different from their places of birth. A total of these future nurses were employed in of 43.5% applied to the CNA/ONA from the trades and industry category, with outside of Scotland, with the largest occupations such as coalminer, pipe number of them, 39%, living and working maker, tailor, and cooper. This category in England. The remainder applied from predominated for nurses who entered the Australia and India. Approximately 29% CNA/ONA during each of the four decades were living in Edinburgh, Glasgow or of the study. Another 17% were employed Aberdeen at time of application, the in the agricultural and fishing category majority of these having been born in (e.g. farmer, crofter, fisherman); 12.7% smaller centres. Another 8.7% were were in the retail and service category residing in the smaller urban areas of (e.g. wine merchant, hotel waiter, Scotland. Only 19.6% of these nurses commercial traveller); and 15.0% can be applied to the CNA/ONA from smaller placed in a professional category (e.g. communities, notably from Ayrshire and
10 medical practitioner, electrical engineer, inspector,’), others were more ambiguous teacher).38 With reference to the Cohort, (‘engineer’, ‘civil servant’). Given the mix of the fathers’ occupations listed on the of backgrounds from which nurses 47 extant application forms at the time of generally came, the candidates must at the nurse’s approach to the CNA/ONA, least ‘present’ as lady-like, as judged by only 10.6% were in the trades and the CNA/ONA recruitment committee, in industry category; 31.9% were in order to be accepted for overseas duty. agricultural and fishing (e.g. farmer, trawl There was no reference to clergymen, owner, skipper and part owner of a fishing gentlemen or lawyers as a parental vessel, dairy owner); 17% in the retail and occupation for any of the 47 nurses in the service category (e.g. innkeeper, billiard Cohort, or the 47 sampled from the room owner, garage owner); and 36.2% in original birth certificates. There were only the professional category (e.g. naval two medical doctors (one in each officer, police inspector, chemist).39 category), only two officers in the British The desired social status of early Navy (Cohort) and none for the British twentieth-century British nurses was that Army or Indian Army, and only one of an ‘educated lady’, a concept of which teacher (Study Group). Were it not for applicants would be aware. 40 Striking the ten farmers for the nurses of the differences exist between the social Cohort, it would be difficult to backgrounds of the CNA/ONA Scottish characterize any significant proportion of nurses for the sample drawn from birth these 94 successful applicants as the certificates and the self-declarations on product of more than the ‘middling’ the application forms submitted by the middle class, or lower – sometimes Cohort. What may be categorized as substantially lower. ‘professional’ stands at 15.0% for the Religion former, and 36.2% for the latter. Miss Mary Lamb, aged 31, daughter of a Agriculture and fishing is 17%, and 31.9%, farmer in the Braes of Glenlivet, respectively, but the key difference is the Banffshire, applied in September 1931 to number of daughters of ‘farmers’ in the the ONA and was sent in 1932 to St. Ann’s Cohort. There were three farmers listed Mental Asylum in Port of Spain, Trinidad, on the 47 birth certificates, and ten as Head Female Attendant. She had farmers on the applications. Others in the trained at the Craighouse Mental Hospital Cohort had fathers who owned dairies in Edinburgh from 1919 to 1923 and held and fishing boats; owners, overall, were a mental care certificate, the Central sparse amongst the birth registrations. Midwife Board certificate (CMB), and was Upward social mobility over time could a state registered nurse (SRN). On account for some of the discrepancy. completion of her contract in 1935, Lamb Certainly, a nurse at an average age of 31 opted not to renew it, but requested at the time of her approach to the instead a posting in the Federated Malay CNA/ONA could have parents who had States. Unfortunately, the Committee of prospered since her birth. Nonetheless, the ONA saw ‘no prospect of further the overall pattern of self-reporting at appointment’ through the Association as time of application is striking. Although Miss Lamb did not possess a general for some of the Cohort, their father’s training certificate (GNC).41 Miss Lamb occupation was stated in a was unusual, not only in this regard of straightforward manner (e.g. ‘police being deemed unsuitable
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Table 4: Occupations of Fathers: A Sample of 47 Birth Certificates for the Study Group (SG) and all 47 Applications for the Cohort
1900-1909 1910-1919 1920-1929 1930-1939 Overall % SG Cohort SG Cohort SG Cohort SG Cohort SG Cohort Trades/ Industry 5 0 3 0 12 2 6 3 55.3% 10.6% Agriculture/ Fishing 1 1 0 1 3 3 4 10 17.0% 31.9%
Professional 0 1 1 1 3 2 3 13 15.0% 36.2% Retail/ Service 1 0 0 0 3 0 2 8 12.7% 17.0%
Other 0 1 0 0 0 1 0 0 0 4.3%
Total 7 3 4 2 21 8 15 34 100% 100% following a completed tour of duty a good past behaviour and reputation and because she did not hold the GNC, but she should have had a religious also for the fact that she was one of only upbringing, with a responsible attitude to two Scottish applicants known to have life and with ‘distinct standards of right been of the Roman Catholic religion. The and wrong’’.44 There was no requirement applicants’ religion for both the Cohort that any referee or guarantor should be a and the 29 future CNA/ONA nurses who cleric and only four out of the 47 trained at the Glasgow Royal Infirmary members of the Cohort named members and the Western Infirmary of Glasgow of the clergy as a reference. The majority was predominantly Protestant. All 29 from used their supervisors from previous the training registers were members of nursing employments as personal Presbyterian churches (Church of references. Very little direct evidence Scotland, United Free Church, and exists in the records of nurses’ religiosity Congregational Church). In the Cohort, or spirituality. As this documentation is 52% of applicants were Presbyterian,42 administrative and bureaucratic in nature, and another 28% declared their religion as it would therefore not be the ideal protestant with no specific denomination location to look for, or assess, spirituality. noted. Of the remainder, 15% identified Separate British organizations existed to as Anglican, of either the Scottish encourage, train, and mentor women who Episcopal Church or Church of England, desired to nurse within Christian and only 4.3% (the afore-mentioned two institutions overseas.45 It is instructive nurses) as Roman Catholic. that the CNA/ONA Registers of Nurses did In many instances, the CNA/ONA was not routinely note the nurse’s religion. In reluctant to recommend Roman Catholic these registers, religion arose in the applicants for overseas postings.43 The section on comments when the religion question on the application form relating (principally Roman Catholic) made an to religion inquired simply ‘of what otherwise suitable applicant difficult to religious denomination’ a candidate was. place. However, the candidate’s references were required to exhibit that she ‘should show
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Conclusion 2. Overseas Nursing Association (ONA) This article has explored the backgrounds Rhodes House Collection, Oxford of Scottish recruits to the CNA/ONA prior University, MSS British Empire 400, Bound Registers of Nurses, Vol. 100, #59. to their entering the nursing profession 3. Areas for further consideration include and suggests significant diversity of early the training of ‘Agents of Empire’ – their life experiences. While the nurses were educational and early career patterns, as raised in virtually every shire of Scotland, well as recruitment objectives and there was a balanced distribution employment patterns. 4. The best initial statement of the issues between rural and urban areas. Some involved in considering nurses as ‘agents’ came from relatively affluent families, but of empire is in Jones M, ‘Heroines of most – particularly at the time of birth of Lonely Outposts or Tools of Empire: the future nurse – were considerably less British Nurses in Britain’s Model Colony: well off. Many were the products of Ceylon, 1878-1948’, Nursing Inquiry 11, households participating in the new 148-60. 5. Rafferty A M, ‘The Seductions of History industrial and commercial Scotland; and the Nursing Diaspora’, Health and others came of age within the more History 7, 2, (2005), 14. Rafferty used a traditional pursuits of fishing, farming, sample of 231 British CNA/ONA nurses. and coalmining. Religious affiliation was 6. Colonial Secretary on the Colonial Nursing perhaps the most consistent variable with Association, The Nursing Mirror and Midwives’ Journal 15, (April-September the great majority identifying as 1912), 194. protestant. 7. Chamberlain M E, ‘An Obligation of The limited research available on British Empire’, The North American Review 170, nursing recruits of this generation 521, (1900), 499. precludes direct comparison with the 8. Maggs C, ‘Nursing History: Contemporary larger Scottish and British cohorts. Practice and Contemporary Concerns’, in Maggs C (ed.) Nursing History: The State However, Rafferty’s study does show that of the Art (London: Croom Helm, 1987), 7- English recruits to the CNA/ONA came 8. from a similar range of social backgrounds 9. Rafferty A M and Solano D, ‘Can lessons as this Scottish sub-set, and that be learned from history: The origins of recruitment from the middling levels of the British imperial nurse labour market: society, the newly skilled working class, A discussion paper’, International Journal 46 of Nursing Studies 44, 6, (2007), 1063. and small landowners was standard. 10. Rafferty and Solano, ‘Can lessons be This current study confirms the learned’, 1062. inconsistency or lack of stereotypical 11. Maggs, ‘Nursing History: Contemporary profile relative to the ‘colonial’ or Practice’, 6. ‘overseas’ Scottish nurse and suggests 12. Devine T M, Scotland’s Empire: 1600-1815 that further investigation into the (London: Penguin Books, 2003), xxvi. 13. Cited in Jenkinson J, Moss M, Russell I, education and experience of the nurses ‘The Royal’ – History of the Glasgow Royal would be informative. Given the above, Infirmary 1794-1994 (Glasgow: Harper the next questions are: by what routes, Collins Manufacturing, 1994), 269. and how fast, did these potential ‘agents 14. Roberts J, ‘British Nurses at War 1914- of empire’ arrive at the CNA/ONA? 1918: Ancillary Personnel and the Battle for Registration’, Nursing Research 45, 3, References (1996), 168. ‘Those with a good Scots tongue in their 1. 15. Dingwall R, Rafferty A M, Webster C, An head are fit to travel over the world.’ Introduction to Social History of Nursing Anonymous Scottish proverb [Internet], (London: Routledge, 1988), 23. ElectricScotland, 1012, accessed January 16. Dingwall et al., Introduction to Social 31, 2013. History, 74. 13
17. Dickson H P, The Badge of Britannia: 33. Lorentzon M, ‘Grooming nurses for the Queen Elizabeth’s Overseas Nursing new century’, International History of Service (Edinburgh: The Pentland Press, Nursing Journal 6, 2, (2001), 5. 1990), 5. 34. Unless stated otherwise, all data in tables 18. Colonial and Overseas Nursing is calculated from the information Associations, ‘Annual Reports,’ 1901- provided for individual nurses in the 1939, N.P. CNA/ONA Registers of Nurses, Vols. 100- 19. Robinson Mrs. C, Story of the Colonial 104, 1899-1939. Nursing Association: From May 1896-May 35. Including Lothian, Clackmananshire, 1909 (Edinburgh: The Pentland Press, Lanarkshire, Dumbartonshire, Fife, and 1909), 13. Renfrewshire. 20. Rafferty and Solano , ‘Can lessons be 36. Maggs C, The Origins of General Nursing learned?’ 1057. (London and Canberra: Croom Helm, 21. Rafferty A M and Solano D, ‘The Rise and 1983), 64. Demise of the Colonial Nursing Service: 37. Brooks J, ‘Structured by class, bound by British Nurses in the Colonies, 1896- gender’, International History of Nursing 1966,’ Nursing History Review 15, (2007), Journal 6, 2, (2001), 13. 147. 38. Information extracted from original birth 22. Dickson, Badge of Britannia, 21. registers, 1899-1937, located in the 23. Rafferty, ‘Seductions of history’, 6. National Register House, Edinburgh. 24. Antrobus Lady E, ‘Work for Women: ‘Other’ category consisted of ‘squatter’ Nurses Overseas’, The Star (March 10, and ‘writer’. 1930). 39. From ONA application form. In the 25. Anon. n.d. Published commentary from Cohort, 14 (or 29.8%) of the fathers were the CNA (Scottish Branch), ONA Archives, deceased at time of their daughters’ Box 132/1. applications to the CNA/ONA. The 26. ONA Archives, ‘CNA Annual Report’, 1902. application form requested that even if 27. CNA Committee of Inquiry Minutes the father was dead ‘his name and (1910), ONA Archives, Box 120. occupation should nevertheless be given’. 28. ONA Archives, ‘Annual Report’, 1939, Box 40. Antrobus, ‘Work for Women: Nurses 131, Item 25. Overseas’. 29. ONA Register of Nurses, Vols. 100-104. 41. ONA Register of Nurses, Vol. 103, 133. 30. CNA/ONA Forms of Application, ONA 42. Included are those who identified as Archives, Boxes 128-130. Church of Scotland (the Kirk), 31. Information from the Registers of Presbyterian, Congregational and Trainees for some of the future CNA/ONA Weslyan. nurses trained in each institution. Lothian 43. For example, Margaret McMahon of Health Archives: LHB1 162-112, 95, 97, Kilkenny, Ireland, in 1927, secured an Royal Infirmary Edinburgh, 1892-1935, 69 appointment to Newfoundland. ONA nurses. Greater Glasgow and Clyde Archives, Box 102, 216. Archives: NHSGGCA HB6/5/105-111, 44. Dickson, Badge of Britannia 17. HB6/5/160-62, Western Infirmary of 45. For example: Sweet H, ‘“Wanted: 16 Glasgow, 23 nurses; and NHSGGCA nurses of the better educated type”: HB95/10/1/1, HB95/10/1/4, HB14/10/3- provision of nurses to South Africa in the 14, Glasgow Royal Infirmary, 11 nurses. late nineteenth and early twentieth 32. For example, see Hawkins S, Nursing and centuries’, Nursing Inquiry 11, 3, (2004), Women’s Labour in the Nineteenth 179-80; Also Peacock M R, A Nurses’ Century (London: Routledge, 2010) for a Indian Log-book, Being Actual Incidents in prosopographical examination of British the Life of a Missionary Nurse nurses at St. George’s Hospital, London, (Westminster: Mission Equipment and 1850-99. Literature, 1925); ‘Nurses’ Missionary League’, British Journal of Nursing (1913). 46. Rafferty, ‘The Seductions of History’, 7.
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APPENDIX A Occupations of Fathers for 47 Nurses from Study Group (at birth) and 47 Nurses of the Cohort 47. (At application) 1900-1909 1910-1919 1920-1929 1930-1939 At birth Cohort At birth Cohort At birth Cohort At birth Cohort Totals TRADES/ INDUSTRY Building trades 2 1 1 2 1 7 Carter 2 2 Clocksmith 1 1 Coalmining 1 1 2 Cooper 1 1 Gilder master 1 1 Ironmonger 1 1 Ironworker 1 1 2 Joiner/ Sawmiller 1 3 1 5 Printer 1 1 1 3 Railway worker 3 3 Shoemaker 1 1 Tailor 1 1 2 AGRICULTURE/FISHING Cattle dealer 1 1 Dairy owner 1 1 Estate Factor 1 1 Farmer 3 1 7 11 Fishing industry 3 2 5 Gameskeeper 1 1 2 Harbour pilot 1 1 Ploughman 1 1 PROFESSIONAL Chemist 1 1 Civil Service 1 2 3 Engineer 1 1 2 3 8 15 Medical doctor 1 1 2 Naval officer 1 1 Police inspector 1 1 Teacher 1 1 RETAIL/SERVICE Travelling sales 1 4 5 Retail 1 1 1 4 7 Food Service 2 2 OTHER 1 1 2
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Public health nursing in Italy, a postcolonial perspective
Olivia Fiorilli, University of Rome la Sapienza
Public health nursing emerged in Italy at try to take very seriously the idea that the end of World War I at the intersection colonialism has affected and affects between local aspirations to the metropole6. colonies and former colonies optimization of the national ‘biological at the same time though, clearly, in resources’ and the tension toward an radically different ways7. The ‘colonial international standardization of public discourse’ haunted – and continues to health methods interpreted by new or haunt – the metropole in different and renewed transnational institutions and pervasive ways. Colonial repertories, agencies. Public health nursing emerged, especially those flourishing around the in the same period, in many different idea of ‘civilizing mission’, offered a countries in east and west Europe and powerful source of meanings, symbols Asia under the auspices of USA-based and imagery that could be used in transnational agencies such as the different contexts, such as public health Rockefeller Foundation or the American and nursing. I would like to work with the Red Cross.1 It was the latter that idea that metaphors, meaning, concepts, patronized public health nursing in Italy, but also practices shifted back and forth an issue which will be returned at the end between metropole and colonies, of this paper. producing a sort of ‘mirror effect’. Anyway Public health nurses were trained nurses in doing so I am taking very seriously who were intended to teach working class Warwick Anderson’s admonition: people, at home (as well as in schools and factories), hygienic norms, healthy It is important to consider the conducts, ‘proper’ bodily practices and ‘colonial’ as a process and aptitudes, modern ways of managing category in the history of one’s own body and ‘biological resources’ medicine and public health more in order to gain an ‘happy, vigorous and generally. By this I mean more productive life’2. This paper does not take than mere accumulation of into account the history of nursing or homologies or family public health nursing in Italian colonies, resemblances, the notion that if it even though it would be worth tracing the looks like something else it must history of Italian voluntary nurses during somehow be related – that all the conquests of Libya in 19113 and medicine, for example, is Ethiopia in 19354, or that of the Italian somehow colonial in its relation Red Cross school for voluntary nurses in to the body of the patient. Tripoli, or, again, the history of Italian Rather, I am suggesting that one nurses working in Tripoli and Bengasi or in can put together a specific ‘Africa Orientale Italiana’. We will briefly genealogy of metaphors, come back later on the School Principessa practices, and careers that links Maria Pia for ‘Arab nurses’ set up in the colony with the metropole Tripoli in 1935, few years after the end of and with other colonies, that one a bloody so-called ‘pacification campaign’ might follow people, in Libya5. technologies, and ideas as they It is the intention in this paper, instead, to move from one site to another8.
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Through the analysis of different texts settlers, but making the colonized people produced by and on public health nurses ‘laborious, healthy and happy’ and in Italy I intend to trace back a genealogy ‘civilizing’ them. What I will attempt to do of some of these metaphors, meaning and is to delineate the background of these practices that moved between different assumptions. It is arguable that the public colonies and colonial contexts and health nurses found the words of the different metropoles. author of this article –RosannaFambri, Back and forth chief of the Fascist Nurses Union, director The starting point in this inquiry is the of the journal and– rather familiar. issue of Infermiera Italiana, the official Public health nurses’ work with Italian journal of the Fascist Nurses Union working class people was always (Sindacato nazionale fascista infermiere described in a similar way. What public diplomate), published after the health nurses were supposed to do was proclamation of the empire by Mussolini disciplining through example - in the most at the official end of the military conquest plain, persuasive way - the hygienic of Ethiopia. The opening article asserts conducts and body practices of simple, that as soon as there will be enough ‘childish’ ‘ignorant’, ‘superstitious’, trained nurses to fulfil the needs of the ‘irrational’, sometimes ‘apathetic’ people. metropole, many voluntary nurses will They had to bring into their ‘poor’, ‘dark’, surely be ready to leave for Ethiopia ‘stinky’, ‘crowded’ houses the ‘rational where: and modern’ teaching of social hygiene, they had to make diffident people trust we have to take care of 7 million medicine and physicians, convince them poor, childish, lazy, cruel, not to follow the ‘irrational’ and superstitious, diffident, ungrateful, ‘superstitious’ advices offered by the greed, indolent, dirty creatures who women of the neighbourhood, ‘le comari’, can become victims of epidemics and or traditional healing practices.10 They had leave entire regions empty. [In to teach them how to manage themselves Ethiopia] we have to protect the in order to be healthy, happy, productive children who are our hope. We’ll be and reproductive, how to become good able to create a new population out mothers and hard workers. of those children, the seed of our It is not a surprise, then, that the teachings won’t be planted in vain. In repertories of the ‘civilizing mission’ her generosity, Italy does not want emerged here and there in the discourses colonies in order to exploit them: Italy about public health nursing. ‘Missionaries doesn’t want to rule on deserts, but of hygiene’, ‘soldiers of peace’, are the on hard working, healthy, happy, titles often used to describe this kind of reproductive populations: that is why nurses. A pamphlet by the Croce Rossa we have to create a perfect sanitary Italiana also recommended that public system in Abyssinia9 [Ethiopia]. health nurses add a ‘work of civilization’ to hygienic assistance.11 This was What is particularly significant for the particularly evident in the description of purposes of this article, is the fact that the the work of public health nurses in places order to give their contribution to the afflicted by malaria, often in the south of colonial enterprise is not assisting and Italy. work nurses are invited to perform in What has been named a process of hygienically defending Italian soldiers or ‘internal colonization’ and a rich history of
17 institutional and popular anti-south imagery in the construction of public racism - that has profoundly shaped the health nursing. The analysis of one of the process of nation-building in Italy - few books published in the 1920’s on the sustained a vision of southern people as topic of public health nursing and less ‘civilized’ and less ‘white’ than Italians especially addressed to nurses or future from the north12. Public health nurses nurses will highlight this ‘trajectory’. The were described as having to deal with the 1926 book, Quasi un romanzo, linee di ‘apathy’, the ‘prejudices’, and the studio e di pratica per le infermiere del ‘superstitions’ of the local peasants, often Littorio17 was a sort of mix between a refusing quinine, distrusting physicians public health nursing textbook and an and medicine and tending to have educational novel that described what a ‘irrational behaviours’ such as hiding their nurse had to be like and what was her disease. The words of Irene di Targiani mission. Its role as a public health Giunti, who was the chief of the Italian textbook, despite its fictional content, Red Cross nurses and secretary of the cannot be downplayed during this inter- Italian Association of Trained Nurses war period, as there were very few (Aniti), about public health nurses in rural manuals available for public health districts are particularly explicit: ‘the nursing. It was published in a series called secret of the public health nurse in rural ‘Biblioteca per le giovani italiane (library districts is knowing their soul. From seven for Italian girls). Elisa Majer Rizzioli, author years ago on – when we began this work of the novel/manual, was among the of penetration in rural districts – real founders of the female fascist miracles happened, especially in the most organization ‘Fasci Femminili’ – an abandoned, most primitive places of organization strongly committed to the southern Italy […] Together with the education of nurses – and one of the most vocation that moves these missionaries, important exponents of the female without which they could not survive this fascism in the 1920s18. She took part to life of deprivation, we came to be the ‘Marcia su Roma’ as a nurse. Rizzioli persuaded that science and experience was also one of the 66 voluntary Red are not less necessary’13. Cross nurses who took part, on a hospital- Public health nurses were also described ship and under the guide of the Duchess as ‘explorers’14, looking for sick people Elena D’Aosta, to the military expedition and exploring poor houses and that brought to the conquest of Libya at neighbourhoods in order to bring back to the end of 191119. She later published a physicians (and institutions) useful memoir on this experience in which she information. They were intended to expressed all her patriotic support for ‘penetrate’15 working class families. Ettore Italian will to bring ‘civilization’ to the Levi, founder of the Istituto di Previdenza ‘black, turbic and barbaric’ Africa, and a e Assistenza Sociale, one of the strongest rampant racism against ‘Arabs’, described advocates of the importance of public as ‘cruel’, ‘non-human’, ‘animal-like’, health nurses, called them ‘personnel of ‘disloyal’ and, most of all, ‘dirty’. This social penetration’, ‘missionaries of this memoir’s first pages can be read as an essential work of civilization’16. interesting ‘hymn’ to whiteness. At the The next pages will focus on a particular beginning of the book Rizzioli evokes the and recognizable ‘trajectory’ along which ship the ‘colonial discourse’ has come to be a […] which brings the white women, source of meaning, metaphors and along with white beds, white cotton
18 and bandages, and goes in the pure an upper class girl called Lorenza, who morning. Who waits for the white comes from a ‘frivolous and wealthy’ women with the red cross? Who family. Due to an unlucky love affair she waits for the pure and white hands of wants to ‘forget herself’ and her problems the sisters and for the healings, the by giving all her energies ‘to the poor bandages, the sweetness? Go ahead populations that have remained backward my white ship, Italian soldiers wait for in the scale of civilization’23. She wants to you and for the white sisters20. become a ‘pioneer of civilization’, both a missionary nun and an explorer. For this This brief piece could offer us and reason she goes to her aunt, an older interesting insight into the troublesome philanthropist and nurse, in order to get self-construction of Italian whiteness and some advices. The latter convinces her its fundamental links to colonialism, that, in order to realize her purposes, she women’s bodies, hygiene and sanitation has to be trained as a nurse. In a central and perhaps even to the history of the dialogue between the two characters, the ‘white sisters’ of the Red Cross. For the aunt literally re-orients the girl’s moment I will simply add that this memoir aspirations, taking the chance to explain was published in 1915, when Italy entered to her what a nurse is basically supposed World War I, in order to offer an example to do: to all the women – especially middle and upper class women – willing to become Shall I be doctor? – Not at all. You’ll nurses in order to do something for their be a propagandist of hygiene and homeland in wartime. The importance of ethics: these are the bases of society. Elisa Rizzioli’s experience with the - I’ll look for the most inhospitable conquest of Libya, is important for this area of Africa. – wouldn’t it be better narrative, not only in order to provide a if you went to Somalia, where the genealogy of her own ‘civilizing and Dutch of Abruzzi […] has changed the colonial fantasies’, which this article will course of the river Uebi Scebeli and explore, but also because this campaign has created plenty of cotton fields? witnessed the first appearance of […] –Yes, my aunt, I’ll create schools, voluntary female ‘modern nurses’ trained getogheters, everything for the by the Croce Rossa Italiana (CRI) in a war children. They’ll learn Italian, our context21. The work of CRI voluntary religion, our songs..- First of all you’ll nurses during the conquest of Libya has teach them how to stay healthy? – been later perceived as a sort of ‘test Teach children how to stay healthy? – bench’ for the involvement of female Sure. If they’ll learn that they have to middle-class nurses in World War I. This wash their teeths every morning, war is a fundamental turning point in the they’ll keep them healthy, if you’ll history of nursing in Italy and a catalyst for teach them to wash themselves the rise of the figure of the female they’ll keep their skin healthy, if ‘modern nurse’22. It could also be argued they’ll be controlled so that they’ll that the colonial war in Libya, represented seat at the table in the proper way, a step in the emergence of this figure: we won’t have myopic or another example of the pervasive hunchbacked […] I’ll have so much to influence of colonialism in Italian nation- do down there. – And what about building. here, in Italy: who will stay here to The main character in Quasi un romanzo is work? Only women already tired for
19 the work they’ve done during the not only as a greed way of defending war, like me and my sisters of the Red Europeans from epidemics, but especially Cross? - I’ll work here with you till I’m as an effective way to teach natives trained, ok? hygiene and to upgrade them materially and morally. We call colonial authorities’ In this dialogue the aunt guides the girl’s attention on the social value of this aspirations from a vague and ‘childish’ experiment and we invite them to adopt desire to ‘civilize uncivilized populations’ similar practices that can bring good to a more concrete and realistic results even at a political level’27. involvement in Italian colonialism and There is no evidence as to whether this finally she re-orients her toward the advice was actually read by Italian desire to ‘regenerate’ Italians themselves. ‘colonial authorities’, but what is known is In Rizzioli’s text ‘the civilizing mission’ that in 1935 the governor of Libya Italo offers a powerful source of meaning that Balbo opened a school for ‘Arab nurses’ supports the poetic and technical with the aim of teaching them ‘first aid construction of what is represented as the and infant hygiene’28. The creation of this ‘ideal nurse’. On the other end, if the school was followed a year later by the ‘colonial discourse’ could represent a opening of another school of the same source of meaning in the construction of kind in Benghasi. As Balbo explained in public health nursing, the latter could 1938, the spreading of hygienic notions offer inspiration in the construction of among Libyan women was ‘fundamental colonial practices as well. Italy, as a for the civilization of the Arab family’29. colonial power, has been – beside the Travelling concepts rhetoric on the ‘civilizing mission’ – The idea of a link between hygiene, good ‘particularly reluctant to create health and civilization, between good institutions and infrastructure dedicated standards of hygiene and health and the to the desired “civilization of natives”’24. development of ‘good citizenship’30, was Italy has been a bloody, brutal and not what had led American Red Cross’ work in particularly ‘sophisticated’ colonial power. Europe toward the end of World War I, as It is worth noting, though, that some Julia Irwin31 has demonstrated. This link discourses about the ‘penetrating between fitness, health and “good potential’ of hygiene circulated in Italy as citizenship” was profoundly rooted in the well as in other empires25. Pasquale Petiti, Progressive era’s way of thinking32. general director of health bureau in If this was the rationale at the base of Somalia and then director of the military American Red Cross’ intervention in hospital in Tripoli, stated in his 1936 Europe, developing ‘good citizenship’ treatise Consigli pratici di igiene e malattie through hygiene was particularly tropicali that health assistance ‘offers a important in a country like Italy that was tool of penetration that has a positive the origin of a massive flow of immigrants influence on the spirit of these primitive to the US: a flow that the US government populations’26. In a short article on the was just about to limit with new laws. ‘No training of Maori public health nurses and one who has watched the embarkation of on their use in the regulation of Maori Italians from their own country or their communities’ health, Ettore Levi arrival at the ports of immigration in remarked: ‘Colonial experience taught us America can be insensitive to the what a powerful tool of penetration desirability of common standards of public health assistance can be, if we intend it welfare work in the two countries’33
20 stated the final report on the work public health nursing in a country that was performed in Italy by a Commission for the origin of a huge immigration flow. Tubercolosis set up by the American Red American Red Cross helped the opening of Cross in 191834. The inception of “modern the first public health nursing schools, methods” of public health management provided teachers, programs and and, most of all, hygienic education in materials for their start up and trained the Italy would have been useful for US in Italian nurses that were going to open order to help the construction of new schools for ‘assistenti sanitarie “valuable citizens” out of not-completely- visitatrici’. In this process it had the civilized immigrants prior to their arrival in opportunity to transmit its own ideas North America: about public health nursing and hygiene, and their ‘civilizing potential’ to Italian assistance to Italy in this field of institutions and nurses. public education [hygienic education Conclusions in schools] – stated American Red This article discussed some of the multiple Cross representatives in the Report ‘trajectories’ along which the repertories – […] in the light of the enormous of the ‘civilizing mission’ have travelled annual tide of immigration, would back and forth between Italy and its bring a large return [to Us] in the colonies haunting the development of elevation of valuable citizens.35 public health nursing. In the last paragraph we explored a further As has been discussed at the beginning of trajectory of the concept of ‘civilizing this paper, the American Red Cross potential of hygiene’, a trajectory that profoundly influenced the inception of originated in a country hosting completely public health nursing in Italy since “the different ‘Italian colonies’ – interesting most important implement of an active enough, this was the name given to Italian campaign in public health was recognized immigrants communities in the Us at the by the commission to be the public health time38 – where other forms of nurse or visitor, who would carry the ‘racialization’39 as well as different instruction given by the physicians on the methods of ‘civilization’, where put in dispensaries directly into the homes of place. the applicants for relief. This agent was As asserted by recent scholarship, practically unknown in Italy’36. ‘postcoloniality’ in the Italian context has a ‘transhistorical and geographically Public health nursing in the US, in the expansive nature’40 that can be better previous years, had already proved to be a understood intertwining colonization, useful ‘tool’ for the management of lower emigration and the marginalization of the classes’ health and bodies and especially 37 South. That is why, in appraising the for those of immigrants (and among emergence of public health nursing in Italy them Italian immigrants) and for their in a postcolonial perspective, it is worth ‘civilization’, literally the process of adopting a wider concept of ‘colonial’. making them into ‘good American References citizens’. At the of World War I American 1. See for example Popova K., ‘Between Red Cross, under the guide of Mary public health and social work: visiting Gardner, who was to be the chief of the nurses in the struggle against poverty and US National Association for Public Health infant mortality in Bulgaria 1923-1934’, in Social Work and Society International Nursing, patronized the inception of Online Journal, 9, 2 (2011), Farley J., To
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cast out disease, a history of the 14. Di Targiani Giunti, I., ‘Preparazione delle International health division of the Infermiere per la propaganda igienica’, Rockefeller foundation (1913-1951), Associazione Italiana per l’Igiene, Atti del (Oxford University Press, 2004). primo congresso nazionale, Napoli, 25-29 2. Istituto italiano di igiene, previdenza e maggio 1922, (Roma, Menaglia, 1923), 4. assistenza sociale, no title, Difesa sociale, 15. Giarri, ‘Le assistenti sanitarie 1, (1922), 4. All translations are mine nell’industria’, Bollettino mensile 3. Bartoloni S., Italiane alla Guerra, dell’Associazione nazionale tra infermiere, l’assistenza ai feriti 1915-18, (Venezia, 27, (1921), 9. Marsilio, 2003), 67. 16. Levi E., La difesa dei valori umani. 4. See La Torre A., Celeri Bellotti G., Sironi Organizzazione nazionale e internazionale C.: ‘A sample of Italian Fascist d’igiene e di assistenza sociale, (Roma, Colonialism: Nursing and Medical Records Istituto nazionale di igiene, previdenza ed in the Imperial War in Ethiopia (1935-36)’, assistenza sociale, 1924) 11. paper read at the UK Association for the 17. Majer Rizzioli E., Quasi un romanzo, linee History of Nursing Colloquium, 4 July di studio e di pratica per le infermiere del 2013, Oxford University. littorio, (Firenze, Le Monnier, 1926). 5. See Del Boca A., Italiani, brava gente?, 18. De Grazia V., How fascism ruled women. (Vicenza, Neri Pozza, 2005), 174. Italy 1922-1945, (Usa, University of 6. With this term the ‘colonial discourse’ California Press, 1992), 57. referred to the national territory (i.e. the 19. Bartoloni S., ‘Da una guerra all’altra. Le ‘homeland’) of a colonial power. infermiere della Croce Rossa Italiana tra il 7. Loomba A., 1911 e il 1945’, in, Goglia L., Moro R., Nuti Colonialism/Postcolonialism,(London, L. (eds), Guerra e pace nell’Italia del Routledge, 1998). Novecento: politica estera, cultura politica 8. Anderson W., Colonial pathologies: e correnti dell’opinione pubblica, American Tropical Medicine, Race and (Bologna, Il mulino, 2006). Hygiene in the Philippines, (Durham NC, 20. Majer Rizzioli E., Accanto agli eroi, Duke University Press, 2006) , 7. crociera sulla Memfi durante la conquista 9. Infermiera Italiana, ‘Italia di Libia, (Milano, Libreria editrice transmediterranea’, Infermiera Italiana, milanese, 1915), 10. 5-6 (1936), 3. 21. Bartoloni S., Italiane alla guerra. 10. See for example Ferreri G., Il contributo 22. Ibidem; See also Bartoloni S., ‘Al delle infermiere professioniste nella capezzale del malato. Le scuole per la terapia infantile’, Bollettino mensile formazione delle infermiere’, in Bartoloni dell’Associazione nazionale tra infermiere, S. (eds), Per le strade del mondo, laiche e 17, (1920), 3, or Pittini F., L’assistente religiose fra Otto e ovecento, (Bologna, Il sanitaria visitatrice nella lotta contro le Mulino, 2007), 217. malattie veneree, considerata come parte 23. Majer Rizzioli, Quasi un romanzo, 131. di un lavoro generalizzato, L’Infermiera 24. Sorgoni B., Parole e corpi: antropologia, italiana, 1-2 (1936), 10. discorso giuridico e politiche sessuali 11. Le infermiere della Croce Rossa Italiana, in interrazziali nella colonia Eritrea, 1890- occasione del 6 convegno infermiere, 1941, (Napoli, Liguori, 1998), 96. Roma 25-28 Settembre 1928, (Roma, s. n., 25. See Bala P. (eds.), Biomedicine as a 1928), 37. contested site. Some revelations in 12. Lombardi Diop C., Giuliani G., Bianco e imperial contexts, (Lexington Books, nero. Storia dell’identità razziale degli 2008); Connerton W., ‘American nurses Italiani, (Firenze, Le Monnier-Mondadori, in colonial settings: imperial power at 2013). bedside’, in D’Antonio P., Fairman J., 13. Atti del Convegno Internazionale delle Whelan J., Routledge Handbook on the infermiere, in occasione della 6. Global History of Nursing (London, Conferenza dell’Unione Internazionale Routledge, 2013), 11-21; Bruchausen W., Contro la tubercolosi: Roma, 25-28 ‘”Practicing hygiene and fighting the settembre 1928, VI (Croce Rossa italiana, natives’ disease”: public and child health Comitato centrale, Roma), (Roma, in German East Africa and Tanganiyka Tipografia Colombo, 1929), 22. territory (1900-1960)’, Dynamis 23-8, (2003), pp. 85-11
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26. Petiti P., Consigli pratici di igiene e 32. Apple R., Perfect Motherhood: Science malattie coloniali, (Torino, Casanova, and Childrearing in America, (New 1936), 14. Brunswick, N.J: Rutgers University Press, 27. Levi, ‘Notizie’, Difesa sociale, 5, may 1922, 2006). 16. 33. American Red Cross, Report of the 28. P. M. R., ‘Sviluppo dell’assistenza in Libia’, Commission for tuberculosis, 36. Infermiera italiana, 4, 1, (1935), 12. 34. See Lavinia Dock, History of American Red 29. Balbo I., ‘La politica sociale fascista verso Cross nursing, (New York, Macmillan, gli arabi della Libia’, in Atti dell’VIII 1922), 867-875. Convegno sul tema: l’Africa, (Roma, Regia 35. American Red Cross, Report of the Accademia d’Italia, Fondazione A. Volta, Commission for tuberculosis, 34. 1938), 742, quoted in Cresti F., ‘Per uno 36. American Red Cross, Report of the studio delle ‘élites’ politiche nella Libia Commission for tuberculosis, 21. indipendente: la formazione scolastica 37. Tomes N., The gospel of the Germs, (1912-1942)’, Studi storici, 41, 1, (2000), (Berkeley: University of California Press, 129. 2006), 187. 30. American Red Cross in Italy, Commission 38. Choate M., Emigrant nation: the making for Tuberculosis, Report of the of Italy abroad, (Cambridge MA, Harvard Commission for Tuberculosis: an attempt University Press, 2008), 3. to establish a method of international 39. Guglielmo J. Are Italians white? How race cooperation in public health and welfare is made in America (London, Routledge, work, (Roma, Tipografia Bertero, 1919), 2003). 43. 40. Lombardi Diop C., Romeo C., ‘Paradigms 31. Irwin J., ‘Sauvons le bebés: Child Health of postcoloniality in Contemporary Italy’, and U.S. Humanitarian Aid in the First in Lombardi Diop C., Romeo C. (eds), World War Era, Bulletin of the History of Postcolonial Italy, challenging National Medicine, 86, 1, (2012), 37-65; Irwin J. homogeneity, (New York, Palgrave Making the world safe, the American Red Macmillan, 2012), 5. See also Curcio A., Cross and a Nation’s Humanitarian Mellino M., ‘Race at work: the rise and Awakening, (Oxford University Press, challenge of Italian racism’, Darkmatter, 2013). 6, (2010) ------
Labour support and high-touch care: A lost art in perinatal nursing?
Sarah-Jane Liva, Geertje Boschma & Wendy Hall, UBC, Canada
Background This paper provides a historical as Norway, 4 midwives delivering low risk perspective on registered nurses’ labour infants in-hospital provide all in-hospital support provision within the North- care; whereas in others, such as Canada American hospital context. In North and the United States, nurses provide care America, registered nurses provide in- during labour and birth at all levels of risk, hospital care for labouring mothers and while the physician, midwife, or labour support is considered an important obstetrician manages complications nursing role as distinct from that of and/or seeks referral for complications, midwives 1 or, within the North-American and delivers the infant. 5 Additionally, in context, nurse-midwives who have the United States, there also exists nurse- obtained specialized training in midwifery. midwives, who are nurses that continue 2 Internationally, there is overlap in the education to become midwives; they roles of midwives and nurses during provide prenatal, labour and birth, and labour and birth; 3 in some countries, such postpartum care. 6
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In this paper we focus on the role of Allegedly, nurses are progressively losing registered nurses providing labour the art of labour support and replacing support to women in labour, sometimes “high-touch care,” 15 with “high tech.” 16 also referred to as obstetrical nurses. Implicit in arguments about a transition Labour support by these nurses is away from high-touch care is the generally defined as advocating for assumption nurses historically provided mother’s choices and providing more ‘high-touch’ labour support with emotional, physical, and informational more hands-on assessment and skill. support during labour and birth.7 Furthermore, this argument assumes Particularly in the current highly high-touch care in the past facilitated technological environment of perinatal more personalized and positive nurse- care, continuous labour support (i.e. 80- patient relationships. 17 We wondered 90% presence) is valued because it is whether these assumptions about an associated with a reduction of alleged better labour support practice in interventions, analgesia, and an increase the past might be based on supposition; in spontaneous vaginal births. 8 Canadian hence, we have looked into the history of women, for example, experience a variety nurses’ labour support provision. of interventions associated with birth; Although it is not entirely clear when this 22% have induction of labour, 91% are alleged move away from high-touch care electronically monitored for fetal heart occurred, it is clear that technological activity, 60% receive epidural analgesia, advances, such as EFM and epidural and 26% give birth via cesarean section, 9 analgesia, became commonly used in while rates for cesarean section are perinatal practice between 1970 and generally similar or higher in other 1990. 18 Thus, those two decades provide countries. 10 Despite potential negative an important venue for exploring how effects of technology, high rates of these technologies influenced high-touch technology use continue because many care. By means of an historical providers work within a risk-averse examination of perinatal care practices culture that supports use of technology as from 1970 until 1990, we explored the supposedly protective of birth literature on labour support in the 1970s complications. 11 and 1980s and conducted oral history In North America, nurses’ ability to interviews with nurses who practiced provide labour support has recently been during this time. questioned because some studies have In this paper, we examine the context of suggested the labour support nurses labour support and birth during the 1970s provide is too limited and does not reduce and 1980s and also give a brief history of analgesia use or cesarean births. 12 This North American hospital birth as a has been attributed to lack of training and background to this domain of nursing role modeling, inadequate staffing, and a practice. By contrasting sociocultural culture favouring technological expertise contexts of the 1970s-1990 with current over labour support skills.13 Specifically, practice, we argue assumptions nurses some authors have argued the historically provided more labour support introduction of labour technologies, such with greater skill are misguided. We also as electronic fetal monitoring (EFM) and argue current ideas about what would epidural analgesia, have heightened constitute best labour support practice nurses’ technological skills to the can be nuanced based on a better detriment of labour support skills. 14 understanding of how labour support
24 provision has evolved as sociocultural the first author. All three worked as staff contexts change. We conclude with a nurses during the 1970-1990 in labour and discussion of the way our historical delivery care at two tertiary Canadian analysis might inform current practice. hospitals; two nurses (Monica and Pat) Methods originally trained in Britain as midwives There is no comprehensive historiography and received nursing registration after of hands-on assessment skills and labour moving to Canada. Monica and Pat were support in perinatal care. Consistent with interviewed together; while both were historical methods, we used document encouraged to contribute equally, Pat analysis to understand how labour often deferred to Monica and agreed with support and hands-on care was her, as evidenced by fewer quotes from constructed between 1970 and 1990 and Pat. how technology was perceived to While the number of oral histories were influence nursing practice during that small and drawn from nurses’ experience time. 19 The Cumulative Index to Nursing in the particular local context of maternity Literature and Allied Health (CINHAL) care in hospitals in British Columbia, these sciences was searched, online (1982- women’s memories seem to reveal a present) and by hand (1970-1981). different context of labour support, Specific journals, such as the Journal of suggesting that current assumptions Obstetric, Gynecologic and Neonatal about past labour support practices might Nursing (JOGNN), Maternal-Child Nursing, need to be revisited. In sharing memories The American Journal of Nursing, and nurses convey what they believe Birth were searched by hand. Reader’s happened, shaped by later life guide retrospective (1970-1982) was experiences and the broader historical searched as well to find popular literature context. 23 Analysis of their stories and nursing texts from this period were provides insight into larger processes of reviewed. No popular literature database social change and as such may provide between 1983 and 1990 was available. one avenue to contextualize and critique To augment textual analysis, oral histories current assumptions. 24 Their views were conducted. Oral histories allow importantly added to the findings from exploration of the sociocultural the literature. understandings about high-touch practice A brief history of birth in North America from those who experienced it. 20 They from 1950-1990 have been deemed a particularly effective By 1950, 95% of all births in Canada and means to uncover “missing evidence” in America were conducted in the hospital. historical research, 21 such as staff nurse 25 Birth practices during the 1950s were perspectives, whose opinions are typically highly regimented to decrease the chance underrepresented in the published of maternal infection and manage the literature. 22 Three registered nurses, sheer number of births during the post- Diane, Monica, and Pat, well able and war baby boom. 26 To facilitate willing to articulate their views, were compliance with obstetric practices aimed interviewed after ethical approval was at efficiency and to meet women’s alleged obtained from the University of British general desire for painless childbirth, Columbia Research Board by the first most mothers were heavily sedated (and author. All three nurses signed consent to often unconscious) during labour and participate and agreed to use their names birth. 27 in text. Oral history transcripts are with
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The declining birth rate in the 1970s birth outcomes. 38 Continuous EFM not meant parents increasingly viewed only increased care providers’ awareness childbirth as a unique experience that of abnormal heart rate patterns but also needed to be satisfying. 28 Fueled by motivated them to intervene; it is intersecting sociopolitical factors, such as considered one of several factors that women’s health, consumer, and natural contributed to the rise in the cesarean childbirth movements, parents challenged birth rate between 1970 and 1990, which medical authority over women’s bodies by increased dramatically from 5.3% to 23%. lobbying for changes to birth practices. 29 39 For example, the natural childbirth In short, between 1970 and 1990, hospital movement became mainstream in the births shifted away from an experience in late 1960s to early 1970s 30 and was based which mothers were sedated and alone to on assumptions that childbirth generally one where they were encouraged to have did not need medical intervention and their partner support them during labour birth preparation could eliminate the and birth. Labour and birth practices need for pain medication and became somewhat more flexible as labour intervention. 31 Women were no longer and delivery rooms were combined and regarded as passive recipients of care, but mothers were permitted to engage in a as active consumers who could prepare variety of practices to cope during labour. for and engage in decisions about birth. 32 40 Mothers increasingly expected healthy By the 1970s, fathers were generally infants in addition to satisfying birth allowed in labour rooms and, by the experiences. 41 1980s, delivery rooms. 33 There was also a Changing understandings of labour shift to rooms designed for women to support and its importance labour, give birth, and sometimes recover Since the 1970s, meanings around the in the postpartum period. 34 concept of labour support and its Technological advancements also changed importance also seem to have evolved. perinatal care, particularly epidural The term labour support is currently analgesia and electronic fetal monitoring understood as a multidimensional (EFM). Epidural analgesia became concept. Currently, four common commonly used in the 1980s and was components in definitions of labour regarded as revolutionary because support include: tangible, emotional, and women were not sedated but could have informational support, and advocacy. 42 virtually complete pain relief during Tangible or physical support includes labour. 35 EFM, introduced in the 1960s measures, such as massage, handholding, for high-risk pregnancies, became effleurage (light abdominal massage), and commonly used in the 1970s. 36 EFM any assistance, such as providing fluids, to allowed nurses to monitor fetal heart increase comfort and reduce pain. 43 rates continuously and was intended to Informational support includes providing reduce the risk of fetal brain damage patients and family with information because nurses could see and respond to about procedures, labour progress, and ominous fetal heart patterns. 37 care options, while emotional support EFM also left a permanent paper record typically relates to verbal encouragement that became relevant as North American that helps reduce anxiety and enhance culture became more litigious and lower coping. 44 Advocacy focuses on supporting neonatal mortality and fewer births patients’ desires for their labour meant families relied heavily on positive experiences. 45
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Furthermore, as a part of labour support intervals and counted the types of provision, nurses are strongly encouraged activities nurses performed during labour to practice one-to-one care, (where a and deliver. 53 Only 6% of activities support person is with a labouring patient performed were considered comfort or 80-90% of the time). 46 While it does not support measures. These findings suggest always occur due to staff constraints (i.e. all nurses did not readily employ nurses are assigned 2 or more patients), supportive care or had other priorities one-to-one care provision is considered that precluded its provision. the epitome of quality labour support Even the idea of one-to-one support may provision because one-to-one care has have been novel between 1970-1990. It explicitly been linked to the use of fewer was only during the early 1970s the first interventions during labour and birth and studies appeared suggesting labour improved maternal satisfaction. 47 support reduced women’s pain In contrast to this current perception. 54 Studies suggesting conceptualization, such a continuous labour support reduced multidimensional conceptualization of obstetric interventions did not appear ‘labour support’ was not present in the until the early to mid-1980s. 55 The idea of literature in the 1970s and 1980s. In 1973, providing continuous, supportive care the Nurses Association of America did not with an alert patient probably was new in include the provision of labour support as the 1970s. Interviewee Diane one of obstetric nurses’ responsibilities 48 remembered being surprised and and the term “labor support” was not thinking, “you’re really trying to do this?” added as a subject heading in the CINHAL when her supervisor began encouraging until 1993. It was only by the late 1980s nurses to stay in patient labour and that the term labour support began to delivery rooms in the late 1980s because emerge in the literature carrying the same the practice was so uncommon. 56 In the connotation as it does today, 49 providing 1970s and 1980s nurses may have been some indication nurses may have had less aware of continuous labour support’s different views about labour support care potential to reduce the need for in the 1970s and early 1980s. obstetrical intervention, which easily From our review of literature between could have translated into unwillingness 1970-1990 it appears one-to-one nursing to provide it among some whereas other care or constant nursing attention may nurses were attracted to the idea. not have been the norm or necessarily Barriers and views about the centrality of expected and the oral histories confirmed labour support provision this view. In the oral history interview Interviewee Monica noted it was the with Diane, 50 she recounted giving birth “number one priority;” although, she did to her children in 1969 and 1973; “I don’t not suggest all nurses shared this view. 57 remember any of the staff” because her When asked how much hands-on support, nurse “was not there.” She described such as massaging and counter pressure being left alone; stating nurses only came (a form of pressure applied to a patient’s to “check my fetal heart once every ½ back to reduce pain during contractions), hour.” 51 That oral history depiction was 58 nurses provided in the 1970s and 1980s, consistent with literature from that time, Pat laughed, stating “we didn’t do that,” which consistently made reference to which may have reflected that she placed nurses leaving patients alone. 52 In 1966, less value on labour support. 59 Diane Tryon observed 30 nurses at 30-minute explained “well, probably half of us gave
27 some value to that, I don’t think that during the 70s and 80s in the United everybody was committed to that at all…I States and Canada. 70 Even if nurses were don’t think I’m being unkind to the staff, skilled labour support providers during they’d just prefer[ed] people to have an the 1970s and 1980s, lack of time may epidural.” 60 Monica echoed this; “there’s have prevented them from giving it. nurses who are really very good at what Exploring differences in you do and there are the nurses who are conceptualizations of skilled labour sitting at the desk when they should be support between 1970-1990 and present giving support to the patient.” 61 Diane Exploring the relationship between the explained some nurses did not provide natural childbirth movement and nursing labour support because they did not illuminates our current conceptualization believe it was effective. 62 This is of skilled labour support provision may supported by Shields’ (1978) study, in not match what was considered skilled which 80 postpartum women were between 1970 and 1990. Today, skilled interviewed about their care. 63 Based on labour support providers are viewed as interview data, each woman’s nurse was creative and skilled at keeping women categorized by the predominant type of informed, supporting their decisions, and care they employed. Similarly to Monica coping. 71 Nurses are portrayed as and Diane’s description of ‘two kinds of facilitators who teach and support nurses,’ 64 25 nurses were found to have families to provide effective labour only provided physical care (i.e. taking support; 72 nursing texts teach nurses how blood pressure), whereas 27 provided to support relaxation, breathing, and both physical and supportive care. 65 The provide physical and emotional support to lack of labour support given by some the labouring mother and her family nurses suggests nurses placed varying members.73 degrees of importance on labour support These current labour support skills seem provision. similar to natural childbirth methods Probably nurses’ ‘valuing’ of labour described in the 1970s. During the 1970s, support was also influenced by staffing women increasingly attended childbirth and the number of patients they had to preparation classes to educate themselves care for. Monica, who viewed labour so they might have a natural birth with support as “a number one priority” also limited intervention and pain medication. noted, “it didn’t happen very often” 74 As with current nursing texts, natural because of “workload.” 66 Continuous childbirth classes taught partners how to labour support would have often been provide physical and emotional support impossible in situations where, as Monica and support their partner to relax and use and Pat described, one nurse and one breathing patterns. 75 In part, the purpose aide were responsible for 5 or 6 actively of natural childbirth methods and labour labouring patients. 67 Diane, noted at her support provision are similar, to support hospital the ratio was one nurse for two labouring women, as are the effects, patients in the 1980s. 68 Often patients reduced exposure to analgesia and laboured by themselves; Monica intervention. explained nurses “didn’t have the Yet, nurses seemed unfamiliar with these resources to do it, and you know, and approaches in the 1970s. One article spend that much time with them.” 69 describing efforts to accommodate Lack of staff and high patient ratios may natural childbirth prepared mothers have reflected the nursing shortages explained nurses were “skeptical and
28 resistant” to natural childbirth techniques. baths, and sterile water injections 76 When discussing “natural childbirth (injections of water into the lower back) methods” in a (1976) nursing text, are believed to interfere with pain McCaffrey 77 explains: processing and reduce labour pain Some of the techniques and pain relief sensation. 80 In the 1970s and 1980s; methods of prepared childbirth initially however, physical comfort techniques appear, in all fairness and at the very described in texts and journals were least, simply odd. Not uncommonly the limited to backrubs, effleurage, bed baths, mothers feel foolish doing them and the and oral hygiene, 81 suggesting nurses nurses are shocked to see them. Hopefully may have held different perceptions the following examples will…encourage around the scope of labour support the nurse to investigate the situation practice in the 1970 and 1980s, as rather than suspect that a laboring compared to current practice. mother is mentally unbalanced. While the literature depicts a global unfamiliarity with natural childbirth McCaffrey does not list methods methods, it is possible nurses were only considered odd, but implies labour unfamiliar with newer techniques, such as support techniques commonly used visualization, aromatherapy, therapeutic today, such as, breathing, positioning, touch, and patterned breathing. The relaxation, and visualization methods (i.e. ‘hallmark’ of the Lamaze method (that breathing in through the mouth/out was associated with natural childbirth) through the nose, changing positions, was patterned breathing, a newer method using massage, visualizing relaxing to cope with labour pain, where the imagery during contractions), were the mother used different breathing ‘odd’ methods, as she continues in text strategies according to her stage in labour suggesting nurses should try to respect to cope. 82 Diane, an advocate of nursing mother’s choices around those methods. labour support and childbirth educator, Some labour support skills considered suggested in her interview nurses at her important and accepted today may have hospital were averse when she taught been unfamiliar and uncomfortable for them to use birthing balls in the labour nurses, at least in the 1970s. 1980s. 83 Moreover, she described having The 1970s and 1980s’ literature and the to attend workshops outside of the oral histories suggested nurses did not hospital setting in the 1980s to learn commonly apply current labour support about labour support modalities, such as techniques at that time. Current nursing aromatherapy and therapeutic touch, texts suggest using many techniques and suggesting nurses in-hospital did not tools, including: therapeutic touch, know about them. 84 massage, aromatherapy, visualization, Unlike today, nurses in the 70s were not sterile water injections, birthing balls, and construed as an important labour support baths/showers, to reduce labour pain. 78 provider; Lamaze and Bradley methods Therapeutic touch involves touching the emphasized the father as labour coach. 85 body to reduce the sensation of pain, In a study examining fathers and nurses’ while visualization includes envisioning a support during labour, it was found relaxing place or looking at photos during fathers were seven times more likely to contractions to help relaxation. 79 Birthing touch the patient, and significantly more balls are exercise balls used for likely to provide a comfort item, such as a positioning during labour, while showers, cool cloth. 86 They were also present 97%
29 of the time, whereas nurses were only Some nurses may have felt labouring present 32%. Patients rated nurses’ mothers did not need elaborate breathing physical support actions during labour as rituals and techniques to cope perceiving significantly less helpful than the fathers. effective labour support was simpler In other words, the influence of the between 1970 and 1990. When asked to natural childbirth movement may have define comfort, Monica described this been substantial towards increasing meant spending time with women and partner labour support, but less so at letting them talk about their concerns affecting the amount of labour support because sometimes all they wanted was nurses provided. you to “say something little to them, say Perhaps nurses’ staffing levels presented how are you doing, rub their back.” 93 barriers to staying with patients Nurses’ views about what constituted continuously, contributing to patient effective supportive care between the perceptions that nurses’ support was less 1970s and 1990 may have not fit our helpful than fathers’ support. current conceptualization making it Alternatively, nurses may not have been problematic to compare labour support taught skills to provide the techniques skill in the past to current practice. now considered necessary for effective Changing understandings about the labour support or had access to labour influence of technology on hands-on skill, support tools, such as birthing balls and labour support, and nurse-patient showers/baths now more commonly relationships used. 87 Monica and Pat described in- While we have highlighted problems room showers and baths were not around assuming past and current labour available in the 1970s and Diane support practice are comparable, it is also described birthing balls were not brought important to highlight that current to her nursing unit until the late 1980s. 88 arguments about technologies’ influence Monica and Pat made no reference to on labour support and hands-on care are using a range of labour support skills, narrowly constructed. Several nurse when asked about the care they provided; historians and researchers recently have they primarily described assessments they argued the preponderance of labour performed. 89 When asked about how technology, such as EFM and epidural pain was managed, Pat only described analgesia, have contributed to a reduction epidural use and Demerol. 90 For Monica, in nurses’ hands-on assessment skills, providing support seemed to be equated along with a reduction in the quality of with providing time rather than labour nurse-patient relationships and labour support care per se, making repeated support. 94 According to these authors reference to being with patients. 91 For EFM has contributed to a loss of hands-on example, she explained she would “spend assessment skill, such as fetal heart as much time as [she] could with the auscultation and contraction palpation, patients” and she “did the best she because EFM can monitor the fetal heart could.” 92 If nurses lacked skills or rate and contraction patterns for the opportunities in the past to give care that nurse. 95 Some noted the availability of might now be considered constituent of epidural analgesia technology in the effective labour support, it undermines 1970s has led nurses to rely on analgesia the current argument the ‘art’ of labour rather than labour support skills to support is being lost. manage labour pain. 96 Furthermore, allegedly EFM and epidural analgesia
30 seem to have inadvertently reduced the had no time.” 105Although, some authors quality of nurse-patient relationships argued the maintenance and because they divert attention away from interpretation of EFM took away from the patients and reduce the need for nurses’ attention to labour support, 106 nurses to touch them. 97 the time nurses’ lost tending to EFM Despite this same discourse taken up in technology may be relative because the current perinatal literature, the view nurses arguably gained time caring for that technology has reduced hands-on fewer patients. It seems the nature of and labour support skills and the quality labour support changed along with the of nursing relationships must be nuanced. transformation of labour support While there is credence to the assertion technology. nurses today may collectively have Another form of technology that has been reduced hands-on assessment skills, 98 targeted for the loss of nurses’ labour which Diane and Monica’s oral history support skills is epidural analgesia. The interviews also supported, 99 the challenge with implicating analgesia is introduction of EFM can be argued to that analgesia use has always been high in have contributed to an increased hospitals, 107 even during the peak of the presence of nurses at the bedside. natural childbirth movement. 108 One Moreover, hospital rates of analgesia have hospital reported Demerol was used 80% persistently been high over time (in the of the time to manage labour pain and 1950s women were also sedated), some hospitals reported epidural rates of independent of epidural analgesia 75% by 1975. 109 In the oral history technology, suggesting nursing hands-on interviews, Pat described nearly all of her care and labour support, has never been patients having an epidural, unless it was sufficient in the avoidance of pain a “quick accelerated labour.” 110 Even medications. 100 nurses supporting natural childbirth EFM use may have contributed to patients were not taught to avoid giving reducing the number of patients nurses pain medications, rather they were to try had to care for, thereby allowing more to give smaller doses and less overall. 111 time for nurses to cultivate nurse-patient The persistently high rate of analgesia use relationships and provide labour support. suggests, independent of labour support EFM interpretation became standardized skill, some nurses have always used pain in the 1980s and nurses were the primary medication during labour. provider responsible for interpretation. 101 If the supposition that nurses were more In 1983, the American Academy of effective labour support providers in the Pediatricians developed the first safe 70s and 80s were valid one might expect a staffing standards dictating nurses should lower rate of birth intervention during only be responsible for one or two that time because effective labour continuously monitored patients; 102 a support is associated with reduced sharp contrast to the 5 or 6 labouring intervention rates. Yet hospital birth has patient ratios to which Monica and Pat never been low-intervention. Despite the referred in the 1970s. 103 As EFM use skill in hands-on assessment skills before increased throughout the 1980s, this EFM, many interventions, such as recommendation increasingly influenced episiotomies, oxytocin use, and forcep staffing. 104 Monica acknowledged such a births were common. In Canada, 35% of shift in nursing care: “now it’s all one to women experienced forceps deliveries in one, so it’s changed…in those days you the 1970s. 112 Leading in to the 1990s,
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75% of women received an episiotomy, 113 support was just emerging during this whereas today that figure is closer to 21% time. Its lack may have contributed to and forcep births, 4%. 114 supportive care collectively holding less While the cesarean section and epidural value than it does today. One-to-one care analgesia rates have increased, it is hardly existed due to higher staff-patient unlikely a decrease in nurses’ hands-on ratios, resulting in patients experiencing and labour support skills could be the sole periods of their labour alone. Even if reason. Birth has increasingly been nurses possessed more skill in providing constructed as a risky process leading to supportive care, it is possible lack of time cultural perceptions that increased to provide this care often prevented medical surveillance and interventions can positive effects. ensure a safe birth. 115 While there is In the technological environment of dissent from normal childbirth perinatal care, it is presupposed that if proponents, research suggests patients nurses are skilled in hands-on assessment are generally favourable to epidural and labour support techniques they would analgesia and have become more be better able to support low-intervention favourable to cesarean section in the last birth. Furthermore, it is presumed that 30 years. 116 Epidural analgesia has nurses were skilled in labour support and increased in popularity, not necessarily hands-on care in the past. Although our because nurses did not provide effective examination suggests nurses may labour support, but in part because it collectively hold less skill in hands-on became more accessible and safe. 117 palpation and auscultation assessment Increasing epidural rates, more positive techniques, the high rates of intervention patient attitudes toward technology and even before the introduction of EFM cesarean section, fear of litigation, suggest nurses’ hands-on skills were not decreasing vaginal breech deliveries, and enough for births to remain low- increasing maternal age and morbidity intervention. Between 1970-1990 may have all have contributed to the anesthesia rates were similar to current current rate of cesarean section. 118 rates. Skill to support low-intervention Nurses’ skill in labour support and hands- birth may not be sufficient to overcome on assessment is relative in the context of workplace environments where high changing sociocultural attitudes towards technology and intervention are the norm birth practices. or to resist sociocultural trends whereby Discussion many patients are favourable to pain This paper adds a historical perspective to relief. 120 As Diane succinctly explained the labour support debate, as previous “the reason we’re not seeing changes [in historical work 119 has only emphasized birth technology rates] right now is the influence of technology on hands-on women don’t want it...those who do are assessment in perinatal care. Nurses may not the majority.” 121 have possessed more hands-on The difference in sociocultural context is assessment skills between 1970 and 1990, important. Historians and sociologists although it would be misleading to caution against nostalgic thinking because assume this meant they provided it hinders reflection on current realities improved labour support, because the and taking action to address them. 122 The literature and oral histories do not suggest latter authors suggest nostalgia has all nurses placed equal value on this care. become increasingly pervasive in a Research supporting the value of labour postmodern society that laments
32 technologies’ inability to fulfill its promise should be redefined given the context of to improve humanity. 123 Likewise, the current practice. Nurses, care providers, promises of epidural analgesia and patients, and nurse leaders need a electronic fetal monitoring to provide an collaborative approach to discuss barriers easier, safer birth have not been nurses face in providing supportive care actualized. Rather, these technologies and devise more comprehensive solutions have changed the context of perinatal than labour support certification. 126 care delivery and created new concerns. References Nurses may have literally provided more 1. Miltner R, ‘More than support: Nursing hands-on care in the past but this did not interventions provided to women in labor’, Journal of Obstetric, Gynecologic, and Neonatal mean analgesia or interventions were less Nursing 31, (2002), 753-61; Payant L, Davies B, common nor that care was necessarily Graham I D, Peterson W E, Clinch J, ‘Nurses’ better. intentions to provide continuous labor support to Historical work is valuable to help women’, Journal of Obstetric, Gynecologic and understand how current concerns have Neonatal Nursing 37, (2008), 405-14; De Vries R, van Teijlingen E R, Wrede S, Birth by Design (New evolved. This study illuminates persistent York: Routledge, 2001). themes in labour support provision. While 2 American College of Nurse-Midwives, Definition we have emphasized nurses may have had of Midwifery and Scope of Practice of Certified high patient care ratios and lack of time to Nurse- Midwives and Certified Midwives. provide supportive care between 1970 www.midwife.org (accessed 14 September 2013). 3 De Vries, van Teijlingen, Wrede, Birth by Design; and 1990, this issue resonates today. Page L, ‘Human resources for maternity care: the Despite a general awareness of the present system in Brazil, Japan, North America, benefits of one-on-one care, often one- Western Europe and New Zealand’, International on-one staffing is still a luxury. 124 Journal of Gynecology and Obstetrics 75, (2001), Similarly, current research suggests there S81-S88. 4Aune I, Amundsen H H, Skagat L C, ‘Is a midwife’s are still ‘two kinds of nurses;’ those who continuous presence during childbirth a matter of highly value supportive care and those course? Midwives’ experiences and thoughts 125 who do not. about factors that may influence their continuous Conclusion support of women during labour’, Midwifery, Epub While significant knowledge can be gained ahead of print 9 October 2013, doi: 10.1016/j.midw.2013.02.001 by exploring the past, imposing nostalgic 5 Smith, C, Belle Brown J, Stewart M, Trim K, ideas on current day practice may lead to Freeman T, Beckoff C, Kasperski M J, ‘Ontario care unrealistic expectations of nurses. We providers’ consideration regarding models of have highlighted the different maternity care’, Journal of Obstetrics and sociocultural environment of nursing Gynaecology Canada 31, (2009), 401-408; Simpson K R, ‘The context and clinical evidence for common practice in the 70s and 80s and argued nursing practices during labor’ The American contextual comparison between past and Journal of Maternal-Child Nursing 30, (2005), 356- current practice is problematic because 363. nurses may have appreciated and 6 American College of Nurse-Midwives, Definition conceptualized labour support differently of Midwifery and Scope of Practice of Certified Nurse- Midwives and Certified Midwives. in the past. For nurse leaders to imply that 7 Adams E D, Bianchi A L,‘A practical approach to reductions in interventions are entirely labour support’, Journal of Obstetrical, within the ambit of alleged supportive Gynecologic & Neonatal Nursing 37, (2008), 106- nursing is to ignore the current 112; Hodnett, E D, ‘Nursing support of the laboring sociocultural context for birth that women,’ Journal of Obstetric, Gynecologic, and Neonatal Nursing 25, (1996), 257-264. supports interventions. Expectations for 8 Hodnett E D, Gates S, Hofmeyr G J, Sakala C, high-touch care and labour support Weston J, ‘Continuous support for women during
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36 perceptions of caring for women in nurse- 112 Low J A, ‘Operative delivery: Yesterday and managed birthing units’, MCN, The American today’, Journal of Obstetricians and Gynecologist Journal of Maternal-Child Nursing 34, (2009), 50- of Canada 131, (2009), 132-141. 56. 113 Klein M, ‘Birth room episiotomy’, Globe and 95 Hoerst, Fairman, ‘Social and professional Mail, 9 April, (1985), 6. influences of the technology of electronic fetal 114 Public Health Agency of Canada, What Mother’s monitoring on obstetrical nursing’, 475; Say: The Canadian Maternity Experiences Survey. Sandelowski, Devices and Desires: Gender, 115 Lee A S, Kirkham M, ‘Disciplinary discourses: Technology and American Nursing. Rates of cesarean section explained by medicine, 96 Sleutal, ‘Nurses’ views of factors that help and midwifery, and feminism’, Health Care for Women hinder their intrapartum care’, 203; Carlton, International 29, (2008), 448-467. ‘Nurses’ perceptions of caring for women in nurse- 116 Tjedje, Price, You, ‘Childbirth is changing, what managed birthing units’, 50. now?’, 144; Green J M, Batson, H A, ‘Have women 97 Sandelowski, Devices and Desires: Gender, become more willing to accept obstetric Technology and American Nursing; Carlton, interventions and does this relate to mode of ‘Nurses’ perceptions of caring for women in nurse- birth? Data from a prospective study’, Birth 34, managed birthing units’, 50. (2007), 6-13. 98 Hoerst, Fairman, ‘Social and professional 117 Wolf, Deliver me from Pain. Anesthesia and influences of the technology of electronic fetal Birth in America; McAllister R G, ‘Obstetric monitoring on obstetrical nursing’, 475; Graham I anesthesia – a two way street’, JOGN 5, (1976), 9- D, Logan J, Davies B, Nimrod C, ‘Changing the use 14. of electronic fetal monitoring and labour support: 118 Green, Batson, ‘Have women become more A case study of barriers and facilitators’, Birth 31, willing to accept obstetric interventions and does (2004), 293-301. this relate to mode of birth? Data from a 99 Spekat, interview, 27 July 2010; Donaldson, prospective study’, 6; Cohn S D, ‘Trends in interview, 10 August 2010. perinatal professional liability’, Journal of Perinatal 100 Wolf, Deliver Me from Pain. Anesthesia and and Neonatal Nursing 1, (1987), 19-27; Taffel S M, Birth in America. Placek P J, Liss T, ‘Trends in the United States 101 Wolf, Deliver Me from Pain. Anesthesia and cesarean section rate and reason for the 1980- Birth in America. 1985 rise’, American Journal of Public Health 77, 102 American Academy of Pediatrics, Guidelines for (1987), 955-959. Perinatal Care. (Illinois: American Academy of 119 Sandelowski, Devices and Desires: Gender, Pediatrics, 1983). Technology and American Nursing. 103 Johnson, interview, 27 July 2010; Spekat, 120 Hodnett, Lowe, Hannah, Willan, Stevens, interview, 27 July 2010. Weston, et al., ‘Effectiveness of nurses as 104 Sandelowski, Devices and Desires: Gender, providers of birth labor support in North American Technology and American Nursing. Hosptials. A randomized controlled trial’, 1371; 105 Spekat, interview, 27 July 2010. Tjedje, Price, You, ‘Childbirth is changing, what 106 Sandelowski, Devices and Desires: Gender, now?’, 144. Technology and American Nursing. 121 Donaldson, interview, 10 August 2010. 107 Mitchinson, Giving Birth in Canada. 1900-1950. 122 Busby H W, ‘Trust, nostalgia, and narrative 108 Wolf, Deliver Me from Pain. Anesthesia and accounts of blood banking in England in the 21st Birth in America. century’, Health 14, (2010), 369-382; Atia N, 109 Bates R C, Helm C W, ‘Epidural analgesia during Davies, J, ‘Nostalgia and the shapes of history’, labour: Why does this increase the forcep delivery Memory Studies 3, (2010), 181-186. rate?’, Journal of Royal Society of Medicine 78, 123 Atia, Davies, ‘Nostalgia and the shapes of (1975), 890-892; Rose L, ‘A pregnant woman’s history’, 181. guide to pain relief for labor and delivery’, 124 Association of Women’s Health, Obstetric, and Glamour, April (1980), 152-157. Neonatal Nursing, Guidelines for Professional 110 Johnson, interview, 27 July 2010. Registered Nurse Staffing for Perinatal Units. 111 Huprich, ‘Assisting the couple through a Lamaze 125 Sleutal, Schulz, Wyble, ‘Nurses’ views of factors labor and delivery’, 245. that help and hinder their intrapartum care’, 203. 126 Kardong-Edgren, ‘Using evidenced-based practice to improve intrapartum care’, 371.
37
‘She dined once at Major Bagot’s with us, has an 18 inch waist, scarlet belt and makes up’: The social exploits and behaviour of nurses during the Anglo-Boer War, 1899 – 1902
Charlotte Dale, University of Manchester
Duty and respectability were two of the duty to serve as a patriotic member of the watchwords used when describing serving wider Empire, or from a desire to nurses during the Anglo-Boer War1. At experience the ‘romantic glamour’ of the commencement of war, nurses and wartime service, hundreds of female women in general, were clamouring for nurses were enlisted into the Reserve the opportunity to experience the during the three-year period of the Anglo- trappings of war and work alongside men Boer War. It is perhaps unsurprising that as equal citizens in the defence and many nurses, and women in general, further expansion of the Empire. By this wished to ‘do their bit’ with an increased period British nurses were familiar with jingoistic sense of patriotism sweeping the the endeavours of Florence Nightingale nation combined with a sense of duty, a during the Crimean War, Anne Thacker’s prominent concept of the period which experiences as a volunteer nurse during was identified as a woman’s call to serve the Franco-German War of 1870 – 1871; as a ‘citizen’ of the Empire.5 Female Florence Lees work ‘In a Fever Hospital nurses would also have been attracted to before Metz’; and Emma Pearson and wartime service by the increased Louisa McLaughlin’s ‘Adventures during opportunities to travel unchaperoned and the War of 1870 – 1871’, all accounts to vicariously experience the theatre of which were available to purchase in war without the censure received by the printed form. In 1883, the Royal Red ‘lady war tourists’ of the Crimean War Cross award was established, with Sister era.6 Janet King a nurse and heroine of the Nevertheless, those nurses enlisting for Anglo-Zulu War of 1879, whose wartime wartime service with the sole intention of work had featured prominently in the personal gratification and increased press, becoming one of its first recipients2. opportunities for travel and social exploits This prestigious award provided nurses would have been condemned by many of with tangible evidence of their service to their nursing peers and by the general the sick and wounded at the seat of war, a public as ‘frivolous’. To be labelled as reward that would place them alongside frivolous during the late Victorian and Florence Nightingale, the nurse who had early Edwardian period, an era heavily become ‘the stuff of which myths are steeped in social ideals concerning the made’ within her own lifetime3. respectability and role of women would On the establishment of the Princess have been considered abhorrent by Christian’s Army Nursing Service Reserve reputable ladies.7 The perceived image of in 1897 the press had stated that, ‘To the the nurse during the nineteenth century average nurse there has long been a was as either the ‘good nurse’, presented rather romantic glamour about the work as a self-sacrificing angel, a woman ready of her calling on behalf of the sea or land to deny all in her dedication to those forces, and the possibility, if attached to within her care. Or the polar opposite, the latter, that she might see (from the the ‘bad nurse’: a woman who would base) something of the actualities of willingly abuse her position of ‘power and war.’4 Whether it was primarily a call of d authority’ for her own ends. These
38 prevalent images of the nurse as either In the afternoon Sisters Friend, Ross, ‘good’ or ‘bad’ are identified by Julia Smyth and I went to Bloemfontein to buy Hallam as the ‘virgin/whore dichotomy’8 a material for fancy dresses for the Variety discourse that continued through the First Race, and we sat up till 12 making them. and Second World Wars, when nurses The most absurd is the ballet girl’s – pink were frequently depicted as either a tarlatan and roses. Mine is a Japanese ‘sexless white angel’ or as a ‘predatory Kimono, and the other two a clown and and highly sexualised’ woman preying on [a] baby.12 the officers or doctors in search of an advantageous marriage.9 Consequently it On another occasion Harris was assigned was imperative for nursing leaders to to night duty but managed to persuade ensure that the public retained the image another nurse, Sister Hopkins, to cover of the ‘good nurse’, with the drive for her shift until 3 am so that Harris could registration and professional regulation attend a local dance leaving at 2 am to continuing apace in Britain. Princess return to complete her duty after ‘plenty Christian personally requested that senior of dancing’ and having enjoyed herself nurses act as moral supervisors over other ‘immensely’ as it ‘was very jolly, we all nurses while travelling to South Africa and went in [our] uniform.’13 During their to provide reports on those who did not service in South Africa, nurses recorded in behave appropriately to the head of the their personal correspondence their many Red Cross and to Princess Christian varied excursions. They recorded their herself.10 Strict control of the nurses daily opportunities for horse riding or how while ensconced in the relative safety of they spent their off-duty hours in learning the ship as to where they should sit at to ride. Nurses attended regular musical mealtimes and the hour of night that they concerts within camps or in local towns, should retire to bed was not possible on croquet and polo parties and went on landing in South Africa where there were numerous picnics across the veldt, numerous opportunities for the nurses to alongside afternoons spent rowing with ‘frivol’. medical officers, before participating in Reserve nurse Emily Wood who was games of cricket and hockey.14 Emily based at the Scottish Royal Red Cross Wood proudly wrote to her family that Hospital in Kroonstad, was invited with she had formed part of the nurse’s team her fellow nurses to attend a ‘Cinderella who were pitted against the hospital’s Dance’ and wrote in her diary that this male cricket team, before going on an invitation had necessitated her taking outing to the zoo to see the springboks.15 time out from her nursing duties to However, not all nurses were desirous of purchase a pair of white silk gloves, a pair opportunities for ‘frivoling’ during their of fancy slippers and some lace, so as to wartime service. Ethel Hope Becher, who make herself a new cape, as the nurses by the period of the First World War was had been forbidden to wear their official Matron-in-Chief of the Queen Alexandra’s uniforms.11 In Bloemfontein where an Imperial Military Nursing Service, had left epidemic of typhoid fever was raging her position at the London Hospital in through the ranks, Dora Harris chronicled December 1899 to enlist as a Reserve in her diary the many social events she nurse.16 Becher, eager to distance herself had attended, despite the vast numbers from accusations of frivoling, wrote in a of infectious cases to be nursed. Harris letter to Sydney Holland, the Chairman of wrote: the London Hospital House Committee, to
39 assure him of the London nurses with those who are simply “frivolling” [sic] respectable behaviour as representatives and getting themselves talked about.’21 of the hospital in South Africa. Becher The preservation of respectability was also stated that, ‘of course we have in many a consideration of Katharine Nisbet, circumstances refused to go to picnics matron of the voluntary Imperial riding & driving parties in company with Yeomanry Hospital in Pretoria, when many khaki clad young men’. She further rumours commenced that she had become asserted unequivocally that she would be engaged to a Mr. Thunder whom she pleased to leave South Africa where: claimed to have never actually had the We are associated in every way with a honour of meeting. Nisbet wrote to her body of women so many of whom one fiancé who was on a posting to Egypt that feels ashamed to think were ever nurses, she had heard that the Mr. Thunder in in fact I have been tempted to wish I had question was already engaged never come out to be mixed up in the (temporarily) to another nursing sister. mind of the public with such a collection.17 The sister had boasted to Nisbet that this Eleanor Laurence recounted in a letter was her ‘5th since coming out’ and had written in May 1901 at the General declared that she was already ‘engaged to Hospital, Natal that: someone at home’.22 Nisbet was There was a big dance the other night consequently anxious to ascertain what about three miles from here, to which her fiancé’s family thought of nurses as twelve of the sisters went, and another she claimed, ‘If I heard the mere fact with night there were some theatricals. I no particulars that a brother of mine was daresay I am wrong, but somehow these engaged to a nurse, call her a Sister or a festivities seem a little out of place while Matron or anything you like, I should be the war is going on. Some of the sisters dreadfully worried till I knew what she was appear to think that they have come out like.’23 This Nisbet attributed to the fact here to have as much fun as they can get, that though some nurses were ‘improved and talk about very little except the men so immensely by uniform…. [and] by the they have been dancing with, and so on.18 regular rules of hospital life… People think them quite charming, so kind, so devoted Laurence remarked how, at first, the and all that when not one in 100 is socially nurses had been encouraged to attend or any other “ally” quite all right.’24 The dances and riding picnics with men, until worrisome behaviour of some nurses in their conduct began to be talked of in an South Africa was to be discussed further by unfavourable manner.19 The nurses were Nisbet who continued: subsequently provided with ‘rules to Robin told us terrible tales of the hospitals conduct’ which Laurence felt no lady at Bloemfontein. He says he has been should have been guilty of in any instance, ashamed to own to having a sister nursing although she was aware that one of her out here. Round where he is they have a fellow nurses had been seen at a hotel at horror of the whole thing, hospitals + all the next station ‘smoking a cigarette with connected with them + to be a nursing a most undesirable companion!’20 The sister is tantamount to being no longer a issue was one that she had cause to return respectable member of society. Isn’t it to again stating that, ‘though there are terrible to think such things can be… They plenty of sisters out here who are working say it is the scandal of South Africa.25 hard and well, they will probably all get classed together in the public estimation
40
Nisbet was consequently aware of the press, questioning the changing role and ramifications to all nurses’ perceived situation of women and in some cases sense of propriety, with respectability illustrating her ‘dreadful behaviour; the contemporaneously understood as a style fin de siècle literature and its shocking of living demonstrating ‘a proper respect implications of free love’.29 This ‘new for morals and morality’.26 woman’ was lamentable to a society Thus, the behaviour and perceived where duty, character and chaste respectability of nurses was a key behaviour were paramount.30 Victorian consideration during the reorganisation society did not view women as equal to process of the Army Nursing Services. In men, women held no right to vote or even 1901 Lieutenant-Colonel Alfred Keogh the opportunity to offer official input in to cautioned the War Office Committee, how their country, and to a larger extent, responsible for the reorganisation of the the Empire, was run.31 Women were seen Army Nursing Services, that in his opinion as both physically and intellectually he did not believe a group of women inferior and hence incapable of dealing could be trusted with the power they with the realities of the male dominated were going to be afforded. Keogh public sphere where all major decisions qualified this as he believed a man to be were made.32 The issue therefore, was much more ‘honourable’ than a woman. not merely how to win equal rights with Women, he continued, were too likely to men, but how to gain recognition for their indulge in ‘petty spites’ and ‘give it hot’ to achievements in a man’s world in their another nurse who usurps their position own right, problematic when faced with when going out into society within the apparent opposition of men such as garrisons to enjoy ‘tea, dances and dinner Alfred Keogh who believed women were parties’. Women could not be trusted not capable of holding positions of power therefore to behave rationally in the face and authority without indulging in ‘petty of social pleasures requiring guidance and spites’ over alleged slights.33 Women support, as Keogh concluded, ‘Women were thus to have a permanent place in have not the same feeling about these the army hierarchy but their authority and things. Theoretically it may be all right, power remained ambiguous and but practically, in a garrison town, where subordinate. these nurses are very much in society, Once it was ascertained that female going out to dinner parties, and all the nurses would hold a permanent place in rest of it, if the Matron-in-Chief is not the the sphere of war it was necessary to head in the society they are in, and goes ensure that there would be no future amongst them and takes the lead, that is scandals at ‘the front’ pertaining to nurses what she will do.’27 behaviour and decorum, or that female Women’s historian Sheila Rowbotham nurses would serve as a distraction to the states that as the twentieth century medical men and officers.34 The nurses approached a new type of woman was who had travelled to the seat of war with required; although opinion differed as to a combined sense of patriotic duty and a how this ‘new woman’ should be defined desire for new experiences, which they and how much freedom she ought to be would not encounter within civilian allowed, a concern evidently shared by practice in Britain, had found themselves the all male War Office Committee.28 The in South Africa with no head of nursing ‘new woman’ debate featured and a lack of defined control over a large prominently in popular fiction and the body of women.35 Following accusations
41 of ‘frivolity’ there was a need not only for social life of the Sisters are very severe reform, but also consideration of the and social intercourse with the Medical future social experiences of nurses during Officers is prohibited.’39 It is also possible periods of war and peace. An article to argue that once in South Africa, nurses entitled: Nurses, You Must Not Dance! by had simply opted to enjoy the varied John Strange Winter in the early years of societal experiences available to them the new service’s creation, relayed the within the diverse environment of a recent discussions in Parliament regarding garrison. Wartime service offered women whether Army Nurses should be the prospect of travelling abroad to permitted to dance in their off-duty experience ‘every exotic detail’ of war, hours. The question was raised in the which for many was viewed as ‘a once-in- House, and Mr. Haldane, the then a-lifetime’ opportunity.40 Nurses also Secretary of State for War replied in a appeared eager to experience the most extraordinary manner. Haldane trappings of war that had previously been stated that he had consulted the Nursing the exclusive domain of men.41 Board on the matter and had been Accusations of ‘frivoling’ were perhaps advised that: merely instances of women, constrained The Nursing Board requires for His in civilian practice by strict social ideals of Majesty’s nursing service gentlewomen respectability and good moral conduct, who are devoted first and foremost to partaking of those social activities readily their work for its own sake and for the available to them on a daily basis in South sake of their patients, and who will, Africa during the last of the gentlemen’s therefore, desire to live quietly and wars, within which the Victorian ideals of unostentatiously without looking for chivalry and a country-club atmosphere of much gaiety.36 polo parties and balls were still adhered.42 The period between the Anglo-Boer War With advancing militarisation and and the First World War appeared recognition of the greater magnitude desirous of nurses who would behave of future wars due to the advancements respectably and not indulge in those of modern weaponry and methods of ‘frivolities’ enjoyed by nurses such as Dora warfare, an efficient and well-regulated Harris, who danced till 2 am during a night nursing service was required. The next shift or Emily Wood buying lace for new war would not be deemed a gentleman’s capes to attend a Ball in South Africa.37 war therefore the variances between the Yet the nurses who enjoyed the varied social experiences of nurses in the First opportunities to ‘go out into society’ World War to those during the Anglo-Boer during their wartime service still War would have been starkly contrasting. demonstrated to many army medical The atrocities of the First World War officials the vital importance of good would certainly have prohibited the nursing to continued military efficiency.38 ‘country club atmosphere’ and detracted This is suggestive that the nurses ‘frivolity’ from the ‘romantic glamour’ and ‘frivolity’ was not entirely detrimental to perceived of previous campaigns. Warfare was views of their professional status. advancing away from the gentlemen’s However, it is apparent that by the period wars of the nineteenth century and nurses of the First World War, only twelve year were consequently required to advance later, that firm control over nurses’ social too. This paper provides a brief insight exploits was in place with one nurse into the social exploits and experiences of noting that, ‘The rules regulating the nurses during the Anglo-Boer War and
42 demonstrates the contemporary attitudes (Eds), The Resilient Female Body: Health and regarding the societal expectations of Malaise in Twentieth-Century France (Bern Switzerland, Peter Lang AG, 2007), 33 – 50, 39 correct moral conduct and how 10. The Needham Papers NCUACS 54/3/95 File accusations of ‘frivolous’ behaviour A.624 Cambridge University Archives impacted on the views of both the 11. Emily Jane Wood, Boer War Nurse’s Journal medical authorities and nurses MS. 6034 (13.09.1900) Wellcome Library themselves. This is certainly an area for 12. Dora Louise Harris, Manuscript Diary (25.08.1900) 1976-11-17 National Army Museum further consideration and examination 13. Harris, Manuscript Diary (23.10.1900) 1976-11- regarding the debates surrounding the 17 NAM changing role of women alongside the 14. Wood, Boer War Nurse’s Journal (26.07.1900) move for registration in Britain with MS. 6034 Wellcome Library nursing reformers of the time stating that 15. Wood, Boer War Nurse’s Journal (26.04.1900) MS. 6034, Wellcome Library ‘the Nurse Question’ was also the 43 16. Ian Hay, One Hundred Years of Army Nursing ‘Woman Question’. The Story of the British Army Nursing Services from References the time of Florence Nightingale to the present day 1. Sally Mitchell, Daily Life in Victorian England (London, Cassell and Company, 1953), 58; Keiron (Greenwood Publishing Group, 1996), 263 Spires, Ethel Hope Becher Boer War Nurses 2. Norman Gooding, Honours and Awards to Database Women to 1914 (London, Savannah Publications, http://www.boerwarnurses.com/main/index.php/ 2007), 203 nurses-databases accessed on 12/02/2013 3. Robert Dingwall, Anne Marie Rafferty and 17. Ethel Hope Becher, ‘Correspondence with Charles Webster, An Introduction to the Social Sydney Holland’ LH/N/7/6 The London Hospital History of Nursing (London, Routledge, 1988), 35 Archives 4. Anonymous, ‘The New Army Nursing Reserve’, 18. Eleanor Laurence, A Nurse’s Life in War and The Daily Telegraph Wednesday, March 31st 1897 Peace (London, Smith, Elder and Co, 1912), 272 Dame Sidney Brown – Press Cuttings 19. Laurence, A Nurse’s Life 282 QA/PE/1/7/BROW Army Medical Services Museum 20. Laurence, A Nurse’s Life 282 5. Jane Lewis, Women and Social Action in 21. Laurence, A Nurse’s Life 282 Victorian and Edwardian England (Aldershot, 22. Katharine Nisbet, ‘Correspondence with Major Edward Elgar, 1991), 11; Anne Summers, James Watson (09.1901)’ 8412-4-112 NAM ‘Ministering Angels -Victorian Ladies and Nursing Emphasis as per original Reform’, History Today Vol. 39 No. 2 (1989), pp. 31 23. Nisbet, ‘Correspondence with Major James – 37, 37 Watson (18.03.1901)’ 8412-4-75 NAM 6. Mitchell, Daily Life in Victorian England 263; 24. Nisbet, ‘Correspondence with Major James Helen Rappaport, No Place for Ladies The Untold Watson’ 8412-4-75 NAM Story of Women in the Crimean War (London, 25. Nisbet, ‘Correspondence with Major James Aurum Press Ltd, 2008), 194 – 198 Watson (28.09.1901)’ 8412-4-116 NAM Emphasis 7. Jill Conway, ‘Stereotypes of Femininity in a as per original Theory of Sexual of Evolution’, In Martha Vicinus, 26. Geoffrey Best, The History of British Society Suffer and Be Still: Women in the Victorian Age Mid-Victorian Britain 1851 – 1875 (London, (USA, Indiana University Press, 1972), 140 – 154, Weidenfeld and Nicolson, 1971), 257 145 27. Discussion of the War Office Committee on the 8. Julia Hallam, Nursing the Image: Media, Culture Reorganisation of the Army Medical and Army and Professional Identity (London, Routledge, Nursing Services (22.07.1901) 6/1956 A700, 138 2000), 20 AMS Museum 9. Philippa Levine, Victorian Feminism 1850 – 1900 28. Sheila Rowbotham, A Century of Women The (London, Hutchinson Education, 1987), 129; Thetis History of Women in Britain and the United States M. Group & Joan I. Roberts, Nursing, Physician (London, Viking, 1997), 7 Control, and the Medical Monopoly: Historical 29. Cecil Willett Cunnington, Feminine Attitudes in Perspectives on Gendered Inequality in Roles, the Nineteenth Century (New York, Haskell House Rights, and Range of Practice (USA, Indiana Ltd, 1973), 283; Barbara Caine, Victorian Feminists University Press, 2001), 176; Alison S. Fell, ‘Fallen (Oxford, Oxford University Press, 1992), 239 Angels? The Red Cross Nurse in First World War 30. Peter T Cominos, ‘Innocent Femina Sensualis in Discourse’, In Maggie Allison and Yvette Rocheron Unconscious Conflict’, In Martha Vicinus (Ed),
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Suffer and Be Still Women in the Victorian Age 37. Harris, Manuscript Diary (23.10.1900) 1976-11- (USA, Indiana University Press, 1972), 155 – 172, 17 NAM; Wood, Boer War Nurse’s Journal 156; Jane Lewis, Women and Social Action in (13.09.1900) MS. 6034 Wellcome Library Victorian and Edwardian England (Aldershot, 38. Anne Summers, Angels and Citizens British Edward Elgar, 1991), 11 Women as Military Nurses 1854 – 1914 (London, 31. Leonore Davidoff and Catherine Hall, Family Routledge Kegan Paul, 1988), 197 and 218; Eric Fortunes Men and women of the English middle Taylor, Wartime Nurse One Hundred Years from class 1780 – 1850 (London, Routledge, 1994), 445 the Crimea to Korea 1854 – 1954 (London, ISIS, – 446 2001), 69 32. George J. Romanes, ‘Mental Differences 39. Miss Bickmore, ‘Ambulance Trains, France’, In between Men and Women’, The Nineteenth Anne Powell (Ed), Women in the War Zone Century Vol. XXI No. 122 (1887), 654 – 670, 654 – Hospital Service in the First World War 655; Bridget Theron, ‘Victorian Women, Gender (Gloucestershire, The History Press, 2009), 90 and Identity in the South African War: a review’, 40. Summers, Angels and Citizens p. 203; UNIS KLEIO Vol. 38 No. 1 (2006), 3 – 24, 3 Rappaport, No Place for Ladies 93 33. J Park, ‘Women of their Time: The Growing 41. Janet Lee, ‘A Nurse and a Soldier: Gender, Class Recognition of the Second Sex in Victorian and and National Identity in the First World War Edwardian England’, Journal of Social History Vol. Adventures of Grace McDougall and Flora Sandes’, 21 No. 1 (1987), 49 – 67, 49 Women’s History Review Vol. 15 No. 1 (2006), 83 – 34. Elizabeth Charlotte Briggs, The staff work of 103, 84 the Anglo-Boer War, 1899 – 1901 (London, G. 42. Paula M. Krebs, ‘The Last of the Gentlemen’s Richards, 1901), 15 Wars’: Women in the Boer War Concentration 35. Lee Holcombe, Victorian Ladies at Work Camp Controversy’, History Workshop Journal Vol. Middle-Class Working Women in England and 33 No. 1 (1992), 38 – 56; Fred R. Van Hartesveldt, Wales 1850 – 1914 (Devon, David and Charles The Boer War Historiography and Annotated (Holdings) Limited, 1973), 82 Bibliography (USA, Greenwood Press, 2000), 32; 36. Dame Sidney Brown – Press Cuttings Rappaport, No Place for Ladies 194 – 198 QA/PE/1/7/BROW Ideas 20th December 1906 AMS 43. Monica Baly, Nursing (London, Anova Books, Museum 1977), 68, D. P. Griffon, ‘“Crowning the Edifice” Ethel Fenwick and State Registration’, Nursing History Review Vol. 3 (1995), 201 – 212, 205
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‘An Unsuitable Job for a Woman?’: Gender and Mental Health Nursing.
Claire Chatterton, Open University & Chair of the History of Nursing Society, RCN
Introduction National Asylum Workers’ Union (NAWU), On the evening of Wednesday 12th May proposed the following motion, ‘That this 1920 a demonstration took place in the city mass meeting … deplores the continued of Wakefield, in West Yorkshire. According employment of female labour in male wards to the ‘Wakefield Express,’1 a large at the West Riding Mental Hospital – work procession with banners flying, and with the which prior to the war was performed by city’s band at its head, marched through the men.’2 streets of Wakefield to the Green Market, It was this topic that had aroused such where a large crowd had assembled. Two passion. For the National Asylum Workers’ lorries acted as platforms for a series of Union, the headline in their magazine speakers. Speakers on the platform included describing this ‘great demonstration’ union officials, local councillors and expresses their views on the issue clearly, representatives from the Discharged Sailors’ ‘Female Nurses in Male Asylums Must Go!’3 and Soldiers’ Association. Mr GW Newsome, Earlier attempts to discuss this matter with secretary of the Wakefield branch of the the asylum’s visiting committee had failed,
44 the speakers said, and had led to this mass unless a satisfactory explanation is given to protest. According to Mr Newsome some the Medical Superintendent, shall be members of the committee had grossly immediately suspended’. 8 insulted them’. One member had told them ‘to shut up and get out.’ Another speaker, As David Russell argues, this great divide was George Gibson (General Secretary of the prompted by Victorian fears about sexual NAWU), called for ‘a clean sweep of the old misbehaviour by male staff towards female fossils who run the asylum.’4 patients and fear of female patients Clearly passions were running high. The becoming pregnant by male staff or patients, objections to the employment of female a significant issue in an era when mental nurses on the male wards appear to have illness was often seen as hereditary.9 two main themes. Firstly they claimed that What led to the breach of the ‘great ex-servicemen were unable to find work and divide’? speakers spoke of their ‘dirty treatment.’ At the protest meeting the employment of Secondly it was not seen 5as women’s work. women was presented as a war time Gibson spoke of the importance of a measure which had continued into peace ‘demarcation line between male and female time. It was undoubtedly true that mental employment … it was absolutely unsuitable hospitals and asylums had suffered severe work for women to be employed looking staffing shortages during the First World after male patients.’6 War. James Gardner, in his study of the West The Great Divide Sussex Asylum, found that by January 1915 The origins of the mass protest in Wakefield the asylum had lost 31 male nurses (or are to be found in the design of the large attendants) to military service, Victorian asylums which were built across approximately one third of the male staff. the United Kingdom. They all shared some Overcrowding, financial pressures and staff common features, in accordance with the shortages led to conditions at the asylum guidelines of the Commissioners in Lunacy. reaching their ‘nadir’, he said, ‘during the One of the most striking of these was the First World War.’ 10 This was replicated strict division of the asylum on gender lines, across Great Britain. Dr. Rambault, Medical with a female side and a male side. Female Superintendent at St. Andrew’s Hospital, attendants or nurses were appointed to Northampton (a private psychiatric hospital) work on the female side and male reported at Christmas 1914 that he had lost attendants on the male side. As Diana Gittins 31 male attendants – thirteen had been says, ‘the spatial division of asylums by called up as reservists and nineteen had gender affected the daily lives and routines volunteered. More left as the war of all who lived and worked within them.’ 7 proceeded.11 Mental nursing was not a Strict rules kept male and female staff apart reserved occupation for men. The National as well as patients. For example in 1914 the Asylum Workers’ Union’s Journal contains Manual of Duties for the County of Essex many obituaries to its members who had Asylums stated – been killed in action. 12 However close examination of the history of ‘Rule 223. The male and female patients mental health nursing reveals that the shall be kept in separate wards and no male introduction of female staff onto the male attendant, servant or patient … shall be side has its origins further back in history allowed to enter the female wards, nor any than the First World War. Fifty years earlier, female to enter the male wards …. Any in 1868, a writer in the Journal of Mental attendant or servant transgressing this rule, Science 13 asks the question, ‘why should
45 female nursing be banished entirely, as it The NAWU however interpreted this almost always is, from the male wards of our differently. For them female labour lunatic asylums?’ He cites the famous represented cheap labour as female nurses psychiatrist, Dr. Maudsley, as a supporter of were paid substantially less than me in this the introduction of female nurses to the period. Therefore employing more female male side and describes an experiment by Dr staff did allow the Scottish medical Crichton Browne at the West Riding Asylum superintendents to improve their staffing (scene of the protests 50 years later) who ratios as more nurses were employed for the introduced a female nurse onto the male same amount of money. 19 side. According to Crichton Browne, ‘good Why the protests? nursing is not to be obtained from blunt, Once this practice became more widespread unsympathising men, however well disposed during the First World War the NAWU’s they may be, it follows as an inevitable leadership pursued a vigorous campaign to corollary that female nurses should be stop it. In January 1916 the union put added to our sick wards wherever forward the following resolution to the possible.’14 Despite the support of these two Labour party’s 15th annual conference – prominent psychiatrists this was not to ‘That this conference records its emphatic become widespread practice in either condemnation of the system, now being England or Wales. increasingly adopted in Public Lunatic In Scotland however things were different Asylums, of substituting female for male and they, it could be argued, led the way in attendants in the care of insane male introducing female staff to the male side of patients at reduced rates of wages, believing the asylum. As Carpenter says, ‘the motives the practice to be morally indefensible, were various.’15 One of the most vigorous detrimental to the welfare of both patients proponents of this was Dr George and nurses, and economically injurious to the Robertson, a leading Medical Asylum service as a whole and calls for its Superintendent, based in Edinburgh. In a immediate abolition.’ 20 series of debates he put forward 3 main arguments, Firstly, he said, male patients Each month a ‘Roll of Dishonour’ or ‘Black would co-operate more with female nurses. List’ was published in their magazine listing He claimed, ‘the presence of women has those asylums who were employing female always had a refining influence on male labour on male wards.21 By 1920, two years society … excited patients who are ready to after the end of the war, the practice fight any man who comes near them, will continued. The union deplored ‘the often do anything they are told by a nurse, degrading system of female nursing of and they will become calm if they receive a insane male patients in asylums’ and argued word of sympathy from her.’ 16 He also that a temporary expedient in war time was argued that asylums should become more being retained in the interests of economy. like hospitals and thus, ‘the employment of In very few asylums, they argued, ‘were the female nurses in the male wards in Scotland women who undertook these revolting was in fact, only a part of a much greater duties paid the male rate of wages for ideal – that of the hospitalisation of the performing male duties.’ 22 asylum.’ 17 Lastly he said that nursing was A small victory was won when the female women’s work, ‘If it could be alleged of any nurses at the Durham County Asylum were asylum that its male wards were not a withdrawn from the male side but other suitable place for women, then the sooner a asylums remained obdurate.23 The union reformation was effected the better.’ 18
46 fought on for the next decade adding new the female side so moving them to the male arguments to support their cause – side was merely exacerbating this process.32 * The union had female members who did * Lastly they claimed that recovery rates not want to work on the male side and they were lower for men in asylums with the were also representing them- ‘a good highest ratio of women on the male side33 number of our female members who had and death rates were higher. 24 experience of this class of work during the What did the female nurses themselves war will tell you that they detest it and are think? entirely opposed to it, although they are As Mick Carpenter says, ‘the campaign compelled to undertake it.’ 24 undoubtedly showed the strength of male * The union also argues they wished to values in the union, although it had some protect women ‘from the moral and physical support among women who did not want to dangers attracting from such work’. 25 One work in the male wards’ 34 As mentioned speaker at the annual conference in 1931 above, for some women working on the said, ‘I have twenty-four years of experience male side was not an attractive proposition of mental hospital work and I would rather and in 1931 a petition to the London County follow my daughter to the cemetery than Council calling for the abolition of this she should go into the male ward for duty.’ practice in the mental hospitals they 26 In 1936 the union’s journal reported the administered contained over 2,400 case of a female charge nurse at the signatures, of which nearly half were female. Crichton Royal, Dumfries, Scotland who had 35 been imprisoned. She had given birth to a However for other nurses, it was something baby in her room in the nurses’ room and they supported. One female nurse in a then smothered it. The father of her baby Lancashire asylum using a pseudonym was a patient. 27 Male patients were also (‘Lancastrienne’) wrote in the union seen as dangerous and case studies were magazine in 1929, ‘it is an insult to a great used to support this point .28 The death of a number of patients to infer that all mental female nurse in France at the hands of a cases are depraved ... It is neither right or male patient was cited. 29 just to deprive them of the ‘human’ touch, * Male patients also needed protecting from and the uplifting influence and help that a female staff, it was posited. Another speaker good trained woman can give them …I have at the union’s annual conference stated, always been treated by respect by the ‘when proper control is absent one may patients, and heard much less bad language assume that the presence of females will than one hears in most workshops’ 36 unduly excite the perverted sexual In 1920 a series of scandals at the Cardiff tendencies of these patients and lead to an Mental Hospital in Wales led to nurses giving increase of such habits, with consequent evidence to the Visiting Committee. Again retardation of their recovery.’ 30 female nurses were in favour of this nursing * Male nurses were better trained than male patients, One, Sister T. Morgan, women. A letter of protest from the Tooting argued, ‘she would nurse male patients in Bec union branch (London) to their local preference to female as they were less paper argued that 45% of the male staff had spiteful.’37 At the Edinburgh Royal Infirmary, completed their training and only 8% of the nurses signed a document to be presented female staff.31 to the Medical Superintendent, George * More pragmatically the union pointed out Robertson, that there were chronic shortages of staff on ‘we, the undersigned, being nurses actually engaged in the nursing of the insane, desire
47 to express our strong disapproval of the a challenge because of their ‘self perception attitude taken by the Asylum Workers Union as workers and employees, untroubled by … and respectfully urge upon you the ideas of vocation or profession.’43 This issue necessity of opposing the Union’s demands was also thus very much about pay and for the abolition of a system which has conditions. proved itself so well adapted to the needs of In his work, Mick Carpenter argues for the our patients.’38 use of a ‘social divisions’ approach. Nursing must not be analysed in isolation he says, This was however interpreted cynically by but in a broader context where issues such the union as being secured under duress, as this are ‘crucially affected by balances of ‘we imagine that woe betide any nurses who power in the wider society, which became refuses to sign.’ 39 represented in the health care system’.44 And what of the patients’ views? Thus debates about women’s work were It is difficult to tell as patients’ voices are much broader than this across the 1920s and largely hidden in the history of mental health 1930s. care. As one female nurse argued in the While this campaign was ultimately union’s magazine, ‘I only wish an impartial unsuccessful though, these insights into a committee could ascertain the poor contentious topic give a fascinating insight patients’ point of view as regards the value into gender roles and stereotypes in mental of our work’40 health care in the early twentieth century. Conclusion References Despite the union’s best efforts female 1. Anonymous, ‘Women Nurses Employed in Male nurses on the male side of mental hospitals Lunatic Wards Wakefield Express, May 15th remained as a feature of many twentieth (1920). century psychiatric institutions and their 2. Anonymous, ‘Women Nurses Employed in Male campaign ultimately failed. It was to be Lunatic Wards some time before male nurses were allowed 3. Anonymous, ‘Female Nursing in Asylum Male to nurse women, or male and female Wards Must Go!’ National Asylum-Workers’ patients were nursed together in mental Magazine, May (1920) 2. 4. Anonymous, ‘Female Nursing in Asylum Male health institutions. Wards Must Go!’ Mental health nursing has followed a 5. Anonymous, ‘Women Nurses Employed in Male different historical path to general nursing th Lunatic Wards Wakefield Express, May 15 and one of the most striking features of this (1920). has the been the much greater numbers of 6. Anonymous, ‘Women Nurses Employed in Male men who have worked in this speciality (as Lunatic Wards also has learning disability nursing). By 1924 7. Gittins, D. Madness in Its Place (London: when the debate that has been discussed Routledge, 1998), 98. was at its height, only two general hospitals 8. Gittins, Madness in Its Place 41 were approved to train men. This period 9. Russell, D. Scenes from Bedlam. (London: also saw the name nurse being applied Bailliere Tindall, 1997). increasingly to male staff in asylums to 10. Gardner, J. Sweet Bells Jangled Out of Tune. replace their former title of attendant. Male (Woodingdean : James Gardner, 1999), 240. nurses thus challenged gendered 11. Foss, A and Trick, K. St. Andrew’s Hospital, stereotypes of nursing as ‘women’s work’42 Northampton. The First One Hundred and Fifty as can be seen in the debates that have been Years. (Cambridge: Granta Editions, 1989). analysed. Mental health nurses were also 12. Carpenter, M. They Still Go Marching On. more unionised and argues Miers, presented (London: COHSE, 1985).
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13. Anonymous, ‘Occasional Notes of the Quarter.’ 31. Anonymous, ‘Female Nursing in Male Wards. Journal of Mental Science (1868), July, 203-204. Tooting Bec Branch Protest’ National Asylum- 14. Anonymous, ‘Occasional Notes of the Quarter Workers’ Magazine (1931), iv. 15. Carpenter, M. Working for Health. (London : 32. Anonymous, ‘Female Nursing in Male Wards’ COHSE, 1988), 31. National Asylum-Workers’ Magazine (1920), 16. Robertson, G. cited in Asylum News (1918), 7-9. January, 8. 17. Robertson, G. ‘Female Nurses in Male Wards of 33. Anonymous, ‘Female Nursing in Male Wards. Mental Hospitals’ British Medical Journal, (1916) Tooting Bec Branch Protest’ National Asylum- Feb. 26, 308-309. Workers’ Magazine (1931), March, iv. 18. Robertson, G. ‘Female Nurses in Male Wards of 34. Carpenter, M. Working for Health. (London : Mental Hospitals’ COHSE, 1988) , 68. 19. Carpenter, M. Working for Health. (London : 35. Anonymous,Second Day’s Proceedings’ Mental COHSE, 1988) Hospital Workers’ Journal (1931), August, 19-21. 20. cited in ‘Female Nursing in Male Wards’ National 36. Anonymous, ‘Female Nurses in Male Asylum Asylum-Workers’ Magazine (1920), January,8. Wards’ National Asylum-Workers’ Magazine (1920), Sept-Oct, 14. 21. e.g. National Asylum-Workers’ Magazine (1920), May, 3. 37. Anonymous, ‘Cardiff Mental Hospital. Female Nurses in Male Wards’ National Asylum- 22. Anonymous, ‘Female Nursing in Male Wards’ Workers’ Magazine. (1920), March, 8. National Asylum-Workers’ Magazine (1920) January, 8. 38. Anonymous, ‘Female Nurses in Male Asylum Wards’. A Morningside ‘stunt’ National Asylum- 23. Anonymous, ‘Meetings at Durham’ National Workers’ Magazine. (1920), March, 9. Asylum-Workers’ Magazine (1920), March, 2. 39. Anonymous, ‘Female Nurses in Male Asylum 24. Anonymous, ‘Second Day’s Proceedings’ Mental Wards’. Hospital Workers’ Journal (1931) August, 19-21. 40. Female Nurses in Male Asylum Wards’ National 25. Anonymous, ‘Second Day’s Proceedings’ Asylum-Workers’ Magazine. (1920), Sept-Oct, 14. 26. Anonymous, ‘Second Day’s Proceedings’ 41. Miers, M. Gender Issues in Nursing Practice 27. Anonymous, ‘Nurse’s Serious Crime’ Mental (Basingstoke: Macmillan, 2000). Hospital Workers’ Journal (1936), April, 20. 42. Davies, C. Gender and the Professional 28. e.g. ‘This and That’ National Asylum-Workers’ Predicament in Nursing (Buckingham: The Open Magazine (1920), Sept.-Oct, p. 9. University Press, 1995). 29. Anonymous, ‘Female Nursing in Male Wards. 43. Miers, M. Gender Issues in Nursing Practice Tooting Bec Branch Protest’ National Asylum- (Basingstoke: Macmillan, 2000), 88. Workers’ Magazine (1931), iv. 44. Carpenter, M. ‘The sub-ordination of nurses in 30. Anonymous, ‘Nurse’s Serious Crime’ Mental health care: towards a social divisions approach’ Hospital Workers’ Journal (1936), April, 20. in Riska, E and Wegar, K (eds) Gender, work and medicine (London: Sage, 1993), 96. ------
Brief Biographies: Law Infirmary at Erdington, near Charlotte Seymour Yapp Birmingham, completing her training in 1903. She then gained her certificate in
midwifery, did private work and worked Claire Chatterton and Lesley Wade as an infant health inspector in
Lancashire. An active member of the Poor Charlotte Seymour Yapp was born in Law Nursing Association, posts followed in October 1879, in Ardwick, Manchester, to Keighley, Halifax, York, West Hartlepool Moses Yapp, a railway guard, and his wife, and Tynemouth before her appointment, Sophia (nee Seymour), a seamstress. She in 1914, as Matron of the Lake Hospital, trained as a nurse at Aston Union Poor 49
Ashton-under-Lyne. She remained there Officer’s Journal6 paid tribute to her for the rest of her career until she efforts saying “Miss Yapp was a member resigned, through ill health, in 1925. She of this body in troublesome days. At that died in 1934.1 time it was no easy task to hold the claims of the poor law in surroundings distinctly hostile…Week after week, month after month, Miss Yapp put the poor law case … in the end they were compelled to acquiesce … the fight is over but the nursing side of the poor law in respect of state registration owes more to Miss Yapp than is realised, the whole poor law is in her debt.” ‘Not in the North’ was the maxim Yapp used at GNC meetings to challenge lowering nursing wages, restrictions on working hours and the setting of unattainable entry requirements and it is clear from the minutes of these early meetings that Yapp had to fight constantly to ensure that her Miss Yapp is little known in nursing history voice, and those she represented, was yet she played, it could be argued, a heard.7 Clearly she was, as one of her significant role in the early days of the main antagonists, Mrs Ethel Bedford General Nursing Council (GNC) for Fenwick, noted, always well informed and England and Wales, and was a doughty ble to put her views forward “forcefully.”8 defender of the interests of Poor Law She was also a prolific author, nursing. Nursing and the health needs of contributing regularly to the Poor Law Lancashire were relatively unknown to the Officers’ Journal. She wrote a series of voluntary hospital matrons of London, lecture notes to probationer nurses9 and who, as a result of the formation of the edited the journal’s nursing section GNC following the Nurses Registration Act between 1910 and 1925. She also of 1919, were crafting new rules, contributed to the first syllabus for nurse regulations and restrictions on nursing, training published by the GNC in 1925, and not always attending to one of the based on the pioneering training scheme largest providers of care, the Poor Law she introduced at The Lake Hospital in nursing service.2 Politically powerful, this 1916.10 She published textbooks on elite London group has previously medical and surgical nursing and dominated nursing history.3 Miss Yapp children’s nursing.11 was appointed to the first caretaker In a poignant letter written to a friend in council of the GNC in 1920. Only four of 1926, after cardiac problems had led to the 16 nurse members represented Poor her enforced early retirement at the age Law Hospitals. She was the only one who of only 46, she wrote “all that I have done had also trained in one.4 In 1923 when the will be forgotten.”12 She deserves to be first GNC council was elected, she was remembered as a pioneering nurse and elected unopposed and served on the author and as a champion of the Poor Law council until ill health forced her nursing service and the needs of sick resignation in 1925.5 The Poor Law children.
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References 1. Wade, L, ‘You need a greater degree of 5. Bendall, E. and Raybould, E, A History of imagination.’ Innovation and sensitivity in the General Nursing Council for England the construction of First World War One and Wales 1919 – 1969. (London: HK Children’s Nursing.’ Unpublished paper Lewis and Co Ltd, 1969). presented at the History of Nursing 6. Poor Law Officer’s Journal April 16th ( Colloquium, University of Hull. (2007) 1925) 2. Kirby, S, ‘Diaspora, dispute and diffusion : 7. Wade,L, ( 2006) op cit bringing professional values to the 8. Bedford-Fenwick, E, ‘Resignations’. British punitive culture of the Poor Law.’ Nursing Journal of Nursing, 73 (1925), 246 Enquiry, 11 (2004), 185-191 9. Kirby, S, (2004) op cit 3. Wade, L, ‘Not in the North’: The Rebellion 10. Wade, L, (2007) op cit of Charlotte Seymour Yapp, Matron, the 11. Jolley, J, ‘Now and Then. Charlotte Lake Hospital, Ashton-under-Lyne (1914- Seymour Yapp’. Paediatric Nursing, 19 1925)’ History Alive – Tameside. (2006), 8- (2007), 12 9 12. Cited in Wade, 2007, op cit 4. Wade, L (2007) op cit
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Obituary: in intensive care in this area before she Lesley Wade (1955-2013) Nurse, opted for a change of speciality to historian and lecturer working with older people. She held one of the first joint appointments between
the School of Nursing at Tameside and the Claire Chatterton, Chair of the RCN’s Nursing Development unit for older History of Nursing Society people. Her then manager, Dame Betty
Kershaw said of Lesley, “She was a star, Nurse historian and lecturer at the pioneering these new roles, teaching and University of Manchester, Lesley Wade practising at an excellent level. She was to (née Savage) has died aged 57. host international nurses who came to see She will be remembered for her the unit …and was to go overseas to teach compassion, professionalism and elderly care. She was in Malta at the enthusiasm about the past, present and hospital there at the same time as Reagan future of nursing. and Gorbachev were having their vital Born in Lancashire, Lesley, met her discussions on concord and co-operation”. husband, Eddy, while sailing, a hobby She then moved to work as a lecturer at which gave her much pleasure and which the University of Manchester and through she enjoyed sharing with her niece, Emily, her work there for nearly twenty years, and nephews, Huw and Rupert. was able to pass on her knowledge and She trained as a nurse in London, at King’s skills to many students. Together with College Hospital, and then moved to work Lesley Waters she was to publish an in the Intensive Care Unit at the important addition to the literature on Westminster, where her identical twin nursing older people in A Textbook of sister, Rosie was training. Understandably Gerontological Nursing: Perspectives on this was to lead to some confusion Practice, in 1996. amongst the hospital staff and was a time Lesley took an active part in nursing that was remembered with great history organisations, including the RCN’s fondness by them both. She then moved History of Nursing Society committee (of back to the North West and was to work
51 which she was Chair and Newsletter Seymour Yapp, an early twentieth century Editor) and the University of Manchester’s matron in Ashton-under-Lyne, who UK Centre for the History of Nursing and championed the cause of Poor Law Midwifery. Amongst her research nursing, then the poor relation of the interests was the career of Charlotte powerful and higher status voluntary hospitals.
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Festival of Learning showcases the also as a means of increasing knowledge History of Nursing about nursing history. It is anticipated that some of the insights will be fed back Angela L. Turner-Wilson, Sarah Keeley, into nursing programmes at Bournemouth Petra Brown, Gill Jordan, Cate Wood, University and any future research University of Bournemouth. projects. Reference The Festival of Learning was an event held 1 at Bournemouth University between the Keeley S, Biley F, Bond C S, ‘Principles and rd th practice of nursing: An oral history investigation of 3 and 14 June 2013, which provided a how nurses learnt their clinical skills,’ The Bulletin forum where staff could share their work of the UK Association for the History of Nursing 1, with members of the general public. 2 (2012), 48-51. Academics in the history of health group (originally set up by the now sadly deceased Associate Professor Dr Francis Biley, and part of the Research Centre of Health, Wellbeing and Ageing) were keen to participate. An exhibition stand was set up for the Festival, and this showcased, amongst other things, the history of nursing (Figure 1). There were old photographs and nursing texts on display, and visitors could view training Figure 1. History of Health Exhibition Stand, slides dating from the 1960s. Some of the Festival of Learning, Bournemouth University. staff wore their old uniforms, and visitors (Photo: courtesy Angela L. Turner-Wilson) could even see some old cardboard hats (see Figure 2). There was a research poster on the history of clinical skills education by Keeley et al1, and there was an opportunity to listen to recordings taken for an Oral History Project which drew on the memories of retired nurses. A number of people came to see the stand, and many of them shared their thoughts about nursing in the past. Some th Figure 2. Old cardboard hat, History of Health offered very different views into 20 Exhibition Stand, Festival of Learning, century healthcare. The exhibition stand Bournemouth University. was a success both in terms of providing (Photo: courtesy Petra Brown) an interesting event for those visiting, but
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‘Colonial and post –colonial nursing’ - After coffee, Dr Aya Homei presented her History Of Nursing Colloquium PhD work where she has investigated the remit and work of Japanese Public Health Allison O’Donnell, University of Dundee Nurses from 1950 until 1970, in supporting and instructing mothers and The UK Association for the History of families in their family planning. Aya Nursing Colloquium 2013 took place at explained that after WWII, the Japanese the University of Oxford, Oxford on the government was subject to American 4th July 2013. This was a truly influences in the way in which family international event with a wide range of planning was directed, with public health presentations exploring the Diaspora of nurses being at the forefront of educating nursing and nursing work overseas and an women as part of national birth control overall theme of where and how nurses experiments. work with people who were in a colonial In the last session before lunch, Dr Barbra setting or who were in areas of conflict Mann Wall gave a detailed and and through missionary work. There elucidatory presentation exploring her were over 80 attendees from an work related to the Medical Missions in international perspective, and within this Nigeria from 1937 until 1970. Barbra also some Masters and PhD students, all explained that this Mission’s work has with an interest in nursing history or mirrored Nigerian society, having to womens’ history. To open the day, change and adapt over this period of time. Professor Anne Marie Rafferty delivered Barbra also noted that her archival the keynote speech, on behalf of sources have also changed, and she has Rosemary Wall as well, and this recently found a RTV link, from which she inspirational presentation was entitled, now has access to small religious [Medical ‘Embodying Nursing’ in the British Empire, Mission] Sisters community in Dublin. 1896-1946’. This paper eloquently After lunch, Dr Sam Goodman took us on explored the recruitment and selection of a literary journey as his presentation, nurses who were sent to work for the ‘Lady Amateurs and Gentleman British Empire in various colony countries. Professionals: Ad-hoc Nursing in the With the use of advertisements from the Indian Mutiny’, which drew on the time, primary interview notes describing primary diaries of the wives of Army the nurses’ physical characteristics and serving officers and other ranks who were personal traits, and photographs of the stationed at Lucknow during the Indian uniforms that nurses were required to Mutiny of 1857. To illustrate his work, wear at all times, Anne Marie brought to Sam utilised known paintings of the day life, the work and roles that the nurses depicting this event, the womens’ dairies adopted during their postings overseas. which were from differing social classes This work overseas, was then continued and from all of these sources Sam as a theme by Dr Susanne Malchau Dietz described the nursing role that the who considered in her paper, ‘Gender, women took in caring for the men who Vocation and Professional Competencies: were injured or died during this mutiny. Deaconesses in the Danish West Indies The Irish theme from Barbra’s paper the 1904-1919’ the role that Danish nurses morning, was continued with Dr Gerard had during this time and also explored the Fealy’s paper, ‘Genial and Accomplished royal patronage which Danish nursing has ladies’: Irish Nursing and the Colonising had. Project’ and explored the role that the
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Irish women carried out when sent to of China – again the use of photographs as different colonies. a record illustrated this well. The theme of going overseas, was carried The last paper of the day was from Anna on into the colloquium and ‘made real’, as La Torre, Giancarlo Celeri Bellotti and with the use of a Skype link, the audience Cecilia Sironi and explored the role of was transported to Australia to see Dr Italian nurses who were working in the Odette Best present her paper on the war zone at front lines of the Imperial War ‘Training ‘The Natives’ as Nurses: So What which took place from 1935 to 1936 in Went Wrong? An Australian Context’. Ethiopia. This paper drew on the nursing This presentation covered, vividly, the and medical records from this time of systematic government lead way in which Fascism, and considered how nurses the Aboriginal peoples of Australia were worked at time of conflict in a Fascist treated in terms of their health care. At state. this time, their culture heritage, health This colloquim was a very interesting and beliefs and land rights were not adhered thought prokoving day. Notably, it was or accepted by the government of the also convenor and organiser, Dr Helen day. Against this societal thinking, Sweet’s last colloquium as Helen retires Odette explained how Aboriginal nurses from her working life, but not from her were trained as they attempted to interest in history and nursing history. To establish a professional role for mark this new chapter in Helen’s life, Dr themselves. Claire Chatterton, Chair of the RCN History After tea break, Dr Susan Armstrong-Reid of Nursing Society and Professor Christine explored the role of Elizabeth Hughes who Hallett from UKAHN, both presented worked as a Guerrilla Nurse with The flowers to Helen to wish her well in her Friends’ Ambulance Unit in remote parts retirement.
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An Accidental historian Nursing's own commission, the Wood Janet Hargreaves, University of Report of 1943 echoed some of the Huddersfield recommendations of Athlone, but particularly wanted to promote nursing as I started my State registration nurse significant career aspiration for women. training in 1975, three quarters of the way The changes espoused by both were through a century which had seen resisted from within the profession and by significant change in nurse education in the powerful hospital administrations2. Britain. The apprentice- based system that Slowly however, curricula did change and emerged out of the Nightingale era was experimental degree level courses started validated as the route to registration to emerge from the 1960s onwards. Full when the General Nursing Council was transition from nursing schools affiliated formed in 19191. The training model was to hospitals, where student nurses were continually challenged by policy directives contracted as trainee employees to full culminating in the Athlone Report of 1939 supernumerary status, a bursary and a that sought to make nurse training university education was negotiated by shorter, more efficient and fit for serving the 1990s and finally sealed with degree the hospital sector. The Royal College of status for all in 2012.
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As a student nurse I was utterly oblivious upon my Dr. of Education and was to these changes. In the county town of searching for a topic for my thesis. Shrewsbury in Shropshire, I joined a Conscious of trying to offer a meaningful traditional nursing apprenticeship. A 6 curriculum in a setting now dislocated week 'pre training school' inculcated into from practice, I wanted to explore the us the values expected, taught us how to extent to which, if at all, the development wear our uniforms and offered a crash of reflective and critical thinking helped course in nursing procedures, anatomy students learn to nurse or made a and physiology. Three years of difference to the care they gave. I was placements typically lasting 12 weeks and wrestling with the methodological including two or four weeks on night duty, challenges this offered when a chance interspersed with 4 week 'blocks ' of study encounter led me in an unexpected introduced me to the range of nursing direction. practice. The military precision of the My mother had always said that she had a nursing rotations was matched by the cousin who had been 'something in regular move from room to room in nursing’. She reminisced about meeting various nursing homes, so that we were her in her nurses’ uniform in their home never more than ten minutes from the district of Walthamstow, London, early in hospital door. World War Two. I can now date this to the There were of course signs of the times period in 1940 when cousin Alice was had I known to look for them. We were completing the district practice section of solemnly informed that we were to have her midwifery training and was stationed our own key to the nursing home front in the Walthamstow area. Alice remained door, and that we were to use this in London, navigating the blacked out responsibly. Our 'set' of around 25 streets on her bicycle, and sleeping in the students included two men and a number hospital basement along with mothers of commonwealth students. At 19 I was and their newborn babies when air raids one of the older students, but a few were made the wards too dangerous. My several years my senior and one married mother was evacuated to Shropshire and student 'lived out'. they did not meet again until we traced In practice most wards had a traditional Alice 55 years later. A frail but spry lady in task oriented policy; the ward sister kept a her 80s Alice was a revelation: sharp, work book for the day listing the activities intelligent, with an encyclopaedic memory that each person was allocated to and a genuine joy in talking about nurses complete. Starting on an early shift at now and in her own past. Alice became 7.15, we checked the book for our for me the 'serendipitous' happening that allocation which might be one side of the Plummer 4 says can lead to the collection ward, one bay, 'baths' or 'investigations' of life histories. which meant doing all the specimen We started to meet regularly and over a collections. However the children's ward period of a few months we constructed was an experimental unit, using and her life history from commencing evaluating the newly envisioned ' nursing tuberculosis nursing in the 1930s to process' that was to become the retirement from a senior educational post backbone of nursing curricula for in the 1970s. Although the whole of her decades.3 career was full of interest, the particular Many years later, now working in higher focus for me became the 10 years (1945- education as a nurse lecturer, I embarked 1955) that she has spent running the 12
55 week pre- training school for a well history from the view point of someone respected nursing school; a precursor to who lived thought it7. As women in the one I had myself attended, and which general and nurses in particular are not had now disappeared from nurse well represented in main stream historical education. research and publications8 this helped me She opened doors that allowed me to to find a critical edge that had eluded me interview nine further retired nurses, and until then. I asked them to remember the aspects of Secondly a major source of data is the pre training school during this same 10 lived memory of nurses. We have a years that contributed to their longstanding narrative culture, and so I understanding of what it was to be, or to found nurses very willing to share the become, a good nurse. I had been reading stories of their nursing lives. The data that Julia Hallam's work on nursing image 5 and can be gained by interviewing nurses is a so, mindful of the professional and public huge, rich resource. Any method that images of nursing as well as the relies on the memory of participants is autobiographical, I also undertook subject to limitations, and historical archival work, visiting the RCN archives in interviews are no different to this. Edinburgh to analyse the Nursing Times However many of the nurses I interviewed and Nursing Mirror which were popular volunteered documents and artefacts that nursing journals of the same period. they had kept, which helped them to Through this research I felt that I began to locate and challenge their recall. These hear the 'voice' that they and the included for example the three year literature from the period used to record they were required to keep, where describe nursing and nurses. I began to each task learned - a bed bath, an understand better the transition from injection - was signed for by the ward individual to nurse, and the ways in which sister, a record book that included all of the training capitalised on class and the nurses shifts, holidays and sickness for gender to mould the recruits into the three years and a beautiful hand sewn 'right kind' of nurses. Then as now, the arm splint which she had made during organisational culture in places where PTS. It was also possible to triangulate nurses practice plus the discourses around their memories with reference to other caring, professionalism, vocation and sources which lead me to the third area gender exert a powerful influence on the which was archives. The archival ways in which what nurses learn in their documentation available to nurse training translates into the way they researchers is extensive and varied. From nurse. I felt that by accidentally stumbling the digitalised Public Records Office to into a historical study, I had achieved small collections relating to individual what I set out to do; to understand better hospitals, a wealth of material can be the ways in which good nursing could be sourced and analysed. supported through education. I started out curious to explore the The richness of data available to me was a relationship between what nurses are revelation and I was hooked on history. I taught and the sort of nurses they used some of the varied sources of become. I now understand more about evidence available to me, critiqued in this by studying the past, than I think I detail by Chatterton6. Firstly life history could have gleaned from researching my research permitted an in-depth contemporaries. Writing now, in 2013, all exploration of an extended period of UK nursing students will gain honours
56 graduate status as well as their nurse History of Nursing (London: Routledge, 1988) 3 registration. Behind them stand the Yura H and Walsh M, The Nursing Process ( New York: Appleton Century Crofts, 1978) shadows of my own nursing training, of 4 Plummer K, Documents of Life 2 (London: Sage, Alice and her nurses 60 years ago, and 2001) beyond them the architects of modern 5 Hallam J, Nursing the Image: Media, Culture and nursing in hospitals, asylums and Professional Identity (London: Routledge, 2000) 6 communities in the 19th century Chatterton C, ‘What is the ‘best evidence’ for researching nursing history?’ The Bulletin of the References 1 UK Association for the History of Nursing, 1, 2 Bendall ERD and Raybould E, A History of the (2012) 5 -20 General Nursing Council for England and Wales, 7 Miller R L, Researching Life Stories and Family 1919 – 1969 (London: K H Lewis and Co.,1969) Histories (London: Sage, 2000) 2 Abel Smith B, A History of the Nursing Profession 8 Simonton D, ‘Nursing History and Women’s (London: Heinemann ,1960); Dingwall R, Rafferty History’ International History of Nursing Journal, AM and Webster C, An Introduction to the Social 61, 1 (2001) 35 -47
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Hotel Dieu in Beaune to oversee the care of the patients in the 30 Carolyn Gibbon, Independent scholar, bedded Paupers' Ward. The nurses of Beaune previously University of Central were held in high esteem as in 1632 the local Lancashire magistrates in Chalon-sur- Saone decided to replace their civil nurses with hospitaller During the summer sojourn to the south of sisters from Beaune. In 1645 further wards France this year, we had the opportunity to are added as the need for care grows. The visit the Hotel Dieu in Beaune. This is a hospital continued to provide care until 1955, remarkable building which was built as a though some care for older people continued hospital in 1443 by Nicholas Rolin, chief until 1984. During the 19th and 20th century justice to the Duke of Burgundy. The hospital the hospital has undergone various was built following a period of famine and restoration projects and in 1988 the hospice epidemics following the Hundred Years War, opened as a museum. Highly recommended, if and dedicated to St Anthony the Abbot. There you are in the area. is evidence of a matron being appointed
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DATES FOR YOUR DIARY
UKCHNM SEMINAR SERIES 2013-2014
(Generously supported by the Manchester Royal Infirmary Fellowship)
Wednesday 25th September 2013: Carolyn Gibbon, University of Central Lancashire, ‘Voices from the Royal Infirmaries’. Room G306A in the Jean McFarlane Building
Wednesday 16th October 2013: Dr Stuart Wildman, University of Birmingham, ‘Nursing the sick-poor at home: the work of the Manchester Nurse Training Institution and its successors 1864-1958’. Room 2.5 in Roscoe Building
Wednesday 13th November 2013: Dr Tommy Dickinson, University of Manchester, ‘“Curing Queers”: Mental Nurses and their Patients, 1935-1974’. Room G306A in the Jean McFarlane Building
Wednesday 19th February 2014: Dr Deborah Palmer, ‘Caring for the nurses? The occupational health of nurses in the late nineteenth and early twentieth centuries’ . Room 2.324 in the Jean McFarlane Building
Friday 14th March 2014: Dr Sue Hawkins, University of Kingston-upon-Thames, ‘In the end, it all comes down to money: nursing in Manchester in the 1860s’. Room G306A in the Jean McFarlane Building
Wednesday 14th May 2014: Dr Rosie Wall, University of Hull, ‘“Training Nurses for the Tropics”: London, Liverpool, Manchester and Edinburgh’. Room G306A in the Jean McFarlane Building
UKAHN COLLOQUIUM 2014
!!ADVANCED NOTICE!!
The 2014 Colloquium will be held in July at Kingston University, Kingston-upon-Thames.
The first day will be the PhD workshop with the Colloquium being held on the second day.
Watch the website for further details and book early, as places will be limited.
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