TITLE PAGE AND DECLARATION
WHO CARED FOR THE CARERS?
A STUDY OF THE OCCUPATIONAL HEALTH OF GENERAL
AND MENTAL HEALTH NURSES 1890 TO 1948
Submitted by Deborah Lyn Palmer, to the University of Exeter as a thesis for the degree
of Doctor of Philosophy in Medical History, November 2009.
This thesis is available for Library use on the understanding that it is copyright material
and that no quotation from the thesis may be published without proper
acknowledgement.
I certify that all material in this thesis which is not my own work has been identified
and that no material has previously been submitted and approved for the award of a
degree by this or any other University.
(Signature)-------------------------------------
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ABSTRACT
This thesis set out to explore the neglected field of nurses’ occupational health.
Evidence from the three case study hospitals confirms that attitudes toward nurses’
health changed between 1888 and 1948. The health of nurses was an issue that was
always taken seriously but each institution approached the problem differently and
responses showed much variation over time. There were good reasons for this but the
failure to adopt a coherent and consistent policy worked to the detriment of nurse
health. This difficulty helps explain the ambiguous treatment of occupational health
within wider histories of nursing. This can lead to the erroneous conclusion that
occupational health was somehow neglected by contemporary actors, thereby
facilitating the omission of the subject from historical studies concentrating on
professional projects and the wider politics of nursing. This study takes a different
approach showing that occupational health issues were inexorably connected to these
nursing debates. Occupational health cannot be understood without reference to
professional projects. This is as true in debates where occupational health was obscured
as it was in cases of overt concern.
The history of the occupational health of nurses is also important because it
offers a new perspective on two other themes central to nursing history, particularly
class and gender. This focus helps understand why attitudes towards the care of sick
nurses changed over time and varied between different types of institutions. By
concentrating on individual nurses’ experiences we reveal something new about the
way national conversations affected ordinary nurses’ lives. Recognition that nursing
presents a serious occupational health risk is a relatively recent phenomenon; it was not
until the 1990s that most nurses had access to occupational health units. This study not
only sheds light on why nurses’ health attracted little attention before the Second World
War but also explains why this situation began to change from the 1940s.
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TABLE OF CONTENTS
TITLE PAGE AND DECLARATION
1
ABSTRACT
2
TABLE OF CONTENTS
3
LIST OF TABLES
5
LIST OF FIGURES
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DEFINITIONS AND ABBREVIATIONS
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CHAPTER ONE Introduction
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Historiography
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Nurses’ Health, Discipline, Class and Gender
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CHAPTER TWO “To Help A Million Sick, You Must Kill A Few Nurses.”
Discipline and Nurses’ Illness 1890-1919
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The London Hospital
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The South Devon and East Cornwall Hospital, Plymouth
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The Cornwall Lunatic Asylum
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Conclusion
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CHAPTER THREE ‘The twelve hours system is a cruel strain on a woman’s
strength and nerve.’ Gender, Class and the Nurse’s Body 1890-1919Error! Bookmark not define
Gender - Was nursing ‘extremely hard work for a woman?’Error! Bookmark not defined.
‘The Trial to Women of the Better Class’
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Occupational Diseases
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Overstrain
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Conclusion
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CHAPTER FOUR A Comparison of Voluntary Hospital and Asylum Nurses’
Roads to Nursing Professionalism 1914-1920
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The Cornwall Lunatic Asylum
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Female nurses and the October 1918 strike
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The South Devon and East Cornwall Hospital
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The College of Nursing versus the Professional Union of Trained Nurses 1919
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Conclusion
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CHAPTER FIVE Nurses’ Registration Bill 1919
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The creation of the Ministry of Health and its attitude to nurses’ registration
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Hours of Employment Bill, 1920
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Unemployment Act of 1920
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The Politics of Nurses’ Occupational Health
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Conclusion
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CHAPTER SIX “The disease which is most feared.” The Interwar Years: the
problem of tuberculosis and its threat to nurses’ health 1930-1948Error! Bookmark not defined.
TB not considered a health risk to nurses 1890-1924
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A threat to nurses’ health 1924-1932
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Case study hospitals in the 1930/40s
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Hospital environment, nurses’ lifestyles and military styles of discipline Error! Bookmark
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Vaccination
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The Prophit Survey
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A compensable disease
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Conclusion
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CHAPTER SEVEN The influence of industrial psychology on the recruitment and
welfare of general and mental nurses 1930-1948
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Industrial Psychology
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The Lancet Commission 1932
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Discipline in the case study hospitals in the 1930s
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Self-Discipline, Freedom and Preparations for War
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The War Years
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Preparations for a National Health Service 1946 -1948
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Conclusion
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CHAPTER EIGHT Conclusion
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Understanding Nurses’ Sickness
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Professional Battles and Management Strategies
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Gender
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BIBLIOGRAPHY
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LIST OF TABLES
Table 1. The number of SDEC probationers who left training because of ill health
1903-1919 ............................................................... Error! Bookmark not defined.
Table 2. Reasons why probationers left South Devon and East Cornwall Hospital 19301940 ......................................................................... Error! Bookmark not defined.
LIST OF FIGURES
Figure 1. The incidence of sickness amongst probationers in the South Devon and East
Cornwall Hospital 1903 - 1928 ............................... Error! Bookmark not defined.
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DEFINITIONS AND ABBREVIATIONS
Attendant
Generally used to describe male nurses until 1919 when it was
replaced by nurse. However, variations occurred between
hospitals. At the Cornwall Lunatic Asylum, the term attendant
applied to both male and female nurses until the early twentieth
century. At The London Hospital, male nurses continued to be
called attendants in the 1940s.
AWA
Asylum Workers’ Association
BCG
Bacillus Calmette-Guering
BJN
British Journal of Nursing
CLA
Cornwall Lunatic Asylum (1850-1930)
CMH
Cornwall Mental Hospital (1930-1948)
GNC
General Nursing Council
HMWC
Health and Munition Workers’ Committee
IFRB
Industrial Fatigue Research Board
IIAC
Industrial Injuries Advisory Council
MRC
Medical Research Council
NAWU
National Asylum Worker’s Union
NCW
National Council of Women
NHS
National Health Service
NICE
National Institute for Health and Clinical Excellence
NIIP
National Institute of Industrial Psychology
Nurse probationer
A nurse in training from 1890 until the early 1920s. The term
then changed to student nurse.
NUTN
National Union of Trained Nurses
NUWW
National Union of Women Workers
PUTN
Professional Union of Trained Nurses
RBNA
Royal British Nurses’ Association
SDEC
South Devon and East Cornwall Hospital (1831-1990)
TB
Tuberculosis
VAD
Voluntary Aid Detachment nurses
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