Medicine, Disease and Society in Britain, 1750 - 1950
Representations and
Practices of Nursing
Lecture 12
Lecture Themes and Outline
Situation up to the ‘Reforms’ of the C19
Reform: Nightingale
Modernisation
Professionalisation- Registration and the
creation of state nursing
Anne Summers’ definition
‘Attending to the needs of the permanently or temporarily
disabled patient; administering food and drink as well as
medicaments; keeping the patient comfortable; keeping
the patient and his surroundings clean; ensuring the
patient is treated as the subject as well as the object of
treatment and helped to keep quiet, calm and cheerful;
medical observation by eye or instrument, of physical or
behavioural reactions to diet and therapy; the patient must
be nursed for as long as the illness continues, regardless of
Outcome’.
Points to consider
Emphasis on care rather than cure
The nurse is seen as necessary to the success of
scientific diagnostic medicine as well as domestic
health care
Nursing requires not only learned skills but qualities of
character – contentious?
From the late C19 onwards nursing becomes
increasingly a paid and professional occupation, but
retains ideas of service. Continued religious link
Women = traditional carers of children and the sick,
associated with selflessness and subordination
Also highly idealised
Nursing in the C19th
‘Since the nineteenth century, nursing
has sought respectability and
modernity by linking its fortunes firmly
with mainstream medicine, and by
seeking a secular model for the
profession to distance it definitively from
its religious, unscientific past’.
(Anne Summers in Loudon, Western Medicine)
Sarah/Sairey Gamp, Dickens’s fictional character, was used by
the growing nursing profession of the nineteenth century to
blacken the reputation of the working nurse who had
provided a service in home and hospital without the benefit of
‘modern’ training.
Before reform
Medieval and early modern period – strong links
between nursing and Christianity
The reformation in Britain led to a more secular
model for nursing
Nursing predominantly the responsibility of the
patient’s family (poor or rich) or was carried out
by neighbours/community
From C18th, nurses were employed by voluntary
hospitals and similar charities – seen as a low
status profession
Nursing duties at the London Hospital, c.
1740
‘To enter upon their Business every morning
at six in Summer and at seven in Winter, to
stop at ten and be in bed by eleven every
Night; to clean their wards, pewter and
utensils every day by seven in the morning;
to attend the patients diligently during their
Watch, and provide them with what is
directed by the Physician, Surgeon and
Apothecary, and see particularly that they
take their medicines, and to keep the beds
of the Patients neat and decent.’
Florence Nightingale, founder
of modern secular nursing
(1820-1910)
Notes on Nursing (1860)
•Health, sanitarian believed in
miasma
• Set up training school for
nurses at St Thomas’ Hospital,
London
• Character as important as
technical skills
• Deeply religious but her
character was far removed
from the sentimental Victorian
imagery of the ‘Lady with the
Lamp’ and the ‘angel of
mercy’.
Nightingale Myth
‘It was not until the great Florence Nightingale
returned in glory from the Crimean War, in the year
1855, that steps were taken to train nurses
systematically for a period of years, after which
they could work independently as professional
nurses. Money publicly subscribed to Florence
Nightingale for her wonderful work in the Crimean
War was used by her to found the Nightingale
School for Nurses at St Thomas’s Hospital. These
Nightingale nurses went to the ends of the earth
founding nurse-training schools, after the pattern of
their alma mater in London.’
Nursing as a Career and Livelihood, G M Hardy
(1955)
Circa 1850:
Florence Nightingale as a Nightingale with her angels
caring for the wounded in an illustration titled
‘Wounded Soldiers and Nightingales’.
Nightingale myth
Rebecca Strong
‘Very little was expected from us, as progress was slow in regard
to organised teaching. Kindness, watchfulness, cleanliness, and
guarding against bed sores were well ingrained. A few stray
lectures were given … There was a dummy on which to
Practice bandaging, and some lessons were given, also a
skeleton, and some ancient medical books, one, fortunately,
on Anatomy for those who attempted self-education’
(trained at St Thomas’s in 1867)
Wider impetus for reform
Impetus for reform came from observing religious
organisations on the Continent
Elizabeth Fry (Quaker) established the Institution of Nursing
Sisters in 1840
Charitable and social welfare movements – nursing missions
and Visiting Societies, which became the forerunners of
District Nursing.
The idea of hygiene, closely related to hospitals during the
C19th, was perhaps just as much to do with middle-class
interest in cleanliness
Typical Nurse’s Experience, c.
1890
‘The nurse went on duty at 7.00am. Much of the work
consisted of washing patients, cleaning wards and
medical equipment, food preparation and serving
(including carrying round brandies and wines for
patients), some tuition, 2 daily prayers. Bed at 9.20
with very short breaks for meals.’
Joan Lane, Social History of Medicine
Nurses in laundry c.1910
St. Bart’s Hospital London c.1908
Campaign for
Registration
Began 1880s
1888 – British Nurses Association formed
1899 – International Council of Nurses
founded
1914-1918 – War raised nurses’ status
1919 – Nurses Registration Act
1941 – National pay scales
Late 19th century campaign for women’s
suffrage.
Aims of Registration
To set up centralised means of control
over nursing- a central body or council of
nurses
Self-government - so nurses should have
a majority and direct representation on
the council
A one-portal system of entry- control over
the curriculum an duration and standard
of training and a single register
Opposition to Registration
The Voluntary Hospital sector who controlled pay and
conditions - wanted Nightingale’s model of the nurse
as a devoted, disciplined, cheap and complaint,
work force, and not upper class.
Matrons also opposed, under the current system they
had an enhanced managerial role and feared
registration would lead to centralisation and they
would lose local control over nurses.
From the medical profession - had many supporters,
including the husband of Bedford-Fenwick.
From nurses who were anti-registration- including
Florence Nightingale.
Anne Witz: Professions and
Patriarchy
‘The passage of the Nurses Registration
Act in 1919 did not represent a victory for
pro-registrationist nurses. The nursing
profession had not come to power.
Instead nurses were henceforth to be
tightly constrained within a stateprofession relation within which they were
the weaker partner, as well as within the
employment relation between hospitals
and nurses and the inter-professional
relation between doctors and nurses.’
Conclusion
Three themes in the development of modern nursing
emerge:
The impact of reformers and pressure groups –
linked with charity, religion and universal suffrage
The rise in the importance of the hospital – nurses
latched onto the development they saw in
medicine
The changing experience of women in society –
private/public spheres – reinforced gender
division