COMPLEX ALLIANCE: A STUDY OF RELATIONSHIPS BETWEEN NURSING AND MEDICINE IN BRITAIN AND THE UNITED STATES OF AMERICA, 1860-1914 A thesis submitted to The University of Manchester for the degree of Doctor of Philosophy in Nursing In the Faculty of Medical and Human Sciences 2013 Sheri Tesseyman School of Nursing, Midwifery And Social Work 2 To David 3 CONTENTS ABSTRACT ..................................................................................................................... 6 DECLARATION .............................................................................................................. 7 COPYRIGHT STATEMENT ........................................................................................... 8 ACKNOWLEDGEMENTS ............................................................................................ 10 THE AUTHOR ............................................................................................................... 12 CHAPTER I INTRODUCTION..................................................................................... 13 Rationale for the study ........................................................................................ 13 Purpose of the study ............................................................................................ 19 Study Questions .................................................................................................. 19 Methodology ....................................................................................................... 20 Selection of material to be studied ...................................................................... 23 Time period ......................................................................................................... 26 Data collection .................................................................................................... 28 Primary and secondary sources .......................................................................... 29 Analysis of sources ............................................................................................. 31 Ethical issues ...................................................................................................... 33 Conclusion .......................................................................................................... 33 CHAPTER II BACKGROUND TO THE STUDY ........................................................ 35 Hospitals and nursing in nineteenth century Britain ........................................... 35 Nursing reform in Britain ................................................................................... 42 Florence Nightingale and the Nightingale School .............................................. 50 4 Nursing work ..................................................................................................... 56 Hospitals and nursing in nineteenth century America ........................................ 60 Nursing reform in America ................................................................................. 65 Nursing work ..................................................................................................... 70 Nursing organisations ......................................................................................... 72 Religious sisterhoods and nursing in America.................................................... 74 Nursing and medicine in America ...................................................................... 76 Organisation of the thesis.................................................................................... 79 Conclusion .......................................................................................................... 83 CHAPTER III NURSING WORK, A ‘THOUSAND LITTLE THINGS’..................... 87 Core nursing ........................................................................................................ 88 Assisting doctors, ‘intelligent nursing’ and ‘stupid nursing’ ............................ 104 Textbooks, nursing, and medicine .................................................................... 108 Conclusion ........................................................................................................ 140 CHAPTER IV NURSES AND DOCTORS ON THE WARDS .................................. 143 Medical students in Britain and America .......................................................... 144 The work of medical students ........................................................................... 151 Medical students and nurses’ work ................................................................... 158 Conclusion ........................................................................................................ 165 CHAPTER V MATRONS, SUPERINTENDENTS, AND THE SEPARATION OF NURSING AND MEDICINE....................................................................................... 166 Ward sisters, head nurses, staff nurses and nurse training ................................ 168 Hospital leadership and social class .................................................................. 171 5 Special probationers .......................................................................................... 178 The British matron ............................................................................................ 187 Superintendents in America .............................................................................. 201 Conclusion ........................................................................................................ 220 CHAPTER VI HARMONY AND DISCORD ............................................................. 224 Harmony and discord ........................................................................................ 225 Dispute at Guy’s Hospital ................................................................................. 228 Conclusion ........................................................................................................ 252 CHAPTER VII NURSES, DOCTORS, AND PHYSIOTHERAPY ............................ 255 Specialisation in nineteenth century nursing .................................................... 256 Massage ............................................................................................................ 259 ‘Angel with a cast iron back,’ nursing and physiotherapy in Britain ............... 260 Nursing and physiotherapy in America ............................................................ 272 Conclusion ........................................................................................................ 279 CHAPTER VIII CONCLUSION ................................................................................. 281 REFERENCE LIST ...................................................................................................... 290 WORD COUNT: 86,044 6 ABSTRACT Nurses and doctors work together in hospitals as they provide care to patients. Nursing knowledge and practice are affected by relationships between nurses and doctors. This study sought to shed light on relationships between nurses and doctors using a broad comparative approach. Relationships between nurses and doctors in Britain and America were examined in order to shed light on the nature of the relationship between nursing and medicine in Britain and America between 1860 and 1914 and to elucidate factors which contributed to the development of this relationship. Examination of the historical roots of the relationship between nursing and medicine may help nurses to develop a deeper understanding of the situation of nursing within healthcare and the ways in which historical factors, such as societal practices and assumptions regarding class, gender, hospitals, and work have affected nursing theory, practice, and status. Studying these issues in two countries may facilitate exposure of factors which might be overlooked in a study of one country alone. This study focuses on hospitals in London and Philadelphia, which were both major centres for development in nursing and medicine during the study time period. The time period for this thesis is 1860 to 1914. It begins with the opening of the Nightingale School at St. Thomas’s Hospital in London in 1860 which served as a model for other hospital training schools for nurses in London and Philadelphia. The bulk of the material for the study comes from the 1880s to the early years of the twentieth century as multiple formal hospital nurse training schools developed in important hospitals in both cities. Various factors were identified which contributed to the context in which nursing developed in London and Philadelphia during the study time period. This study examines conceptualisations of nursing and nursing work in relation to medicine and doctors’ work particularly through Nightingale’s writings and the elaboration of her ideas by her friend Eva Luckes, matron of the London Hospital as well as material in nursing textbooks. The study also looks at relationships between nurses and medical staff as they worked on hospital wards, particularly the effect of the presence of many medical students on the wards of London hospitals and their absence in Philadelphia. The importance of strong nurse leaders within hospitals in regard to separation of hospital nursing and medical services is examined. Harmony and discord between nurses and doctors is examined in order to understand factors which contributed to tensions between doctors and nurses. The