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October 1996
Volume 60 |
Number 10
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| Nursing Through
the Mid-19th Century |
C. Ronald Stephen, M.D.
Wood Library-Museum of Anesthesiology
Modern nursing care, as the term is known today, can trace its
beginnings to Florence Nightingale (1820-1910), whose dedication
to helping the sick and injured was the catalyst for nursing having
developed into the respectable profession it is today.
During the previous millennia, nursing struggled in its efforts
to obtain stature in the art of tender, loving care for the sick.
In Greek mythology, two daughters of Asclepius assumed roles in
the health of patients, Hygeia as the Goddess of Health and Panacea
as the Restorer of Health. In ancient Greece, spas and health
resorts were established for the sick and were directed by physicians.
Gradually, hospitals began an association with the care of the
injured and sick. In Rome, the first large hospital was established
by a Greek Christian woman, Fabiola. In 330 C.E., the Emperor
Constantine founded a large hospital in Constantinople, and Saint
Basil of Athena erected a large institution. The Roman Catholic
Church founded the Hôtel Dieu Hospital in Lyons (592 C.E.)
and the Hôtel Dieu Hospital in Paris (650 C.E.). In the
eighth to 10th centuries of the common era, hospitals were constructed
by the Moslems in Iraq, Syria and Egypt.
The art of nursing in the Middle Ages was relatively simple.
It provided for the physiologic needs of patients, administered
medications, and dressed wounds and ulcers. Discipline was strict;
early nursing was steeped in a tradition of obedience to superiors,
dating back to the Middle Ages.
Catholic Nursing Orders
The Augustinian Sisters took charge of the Hôtel Dieu Hospital
in Paris. St. Catherine of Siena (1347-1380) established her order
(her lamp was the model for Florence Nightingale's lamp in the
Crimean War) at the hospital of LaScala, which is still standing
as her memorial. St. Hildegarge, a Benedictine abbess in Germany,
trained young noblewomen in the care of the sick in her abbey.
The Ursuline Sisters, established in the 16th century, emphasized
the care of the sick and the injured.
Secular Organizations
The Third Order of St. Francis of Assisi improved nursing care
in the communities in which members of the order lived. The Order
of St. Vincent de Paul founded a nursing order with Louise de
Gras in Paris called the Sisters of Charity, which trained young
women to become nurses. The Beguines were lay nurses organized
in 1170 by the priest Lambert de Begue; the order grew to more
than 200,000 members who nursed the sick or taught in The Netherlands,
France and Germany.
Then came the dark ages of nursing. The Protestant Reformation
upset the Catholic organizations that had been established. In
England alone, more than 100 hospitals were closed. The aura of
the Catholic Church faded into relative obscurity, and nurses
were drawn from the lower strata of society. The Protestants were
immune to the concept of freedom of action for women; the concept
of careerwomen was unthinkable since a woman's place was thought
to be in the home. Consequently, nursing as a career lost its
organization and social standing. Nursing itself became a blotch
in 17th- and 18th-century society. During this relative void came
the Industrial Revolution and new thinking in the natural sciences,
political philosophy and the wonders of the machine age. With
it came hospital reform and construction. As workers concentrated
in large cities, large hospitals were founded in London, Grosse
Charities in Berlin, Allgemeines Krankenhaus in Vienna and the
pavilion system in French hospitals.
However, nursing as an inviting profession lay in the doldrums,
although some attempts were made to revive it in the early 19th
century. In Ireland, lay nursing institutions were initiated by
the Sisters of Charity and the Sisters of Mercy (1812-15). The
latter group sent branches to many parts of the world, e.g., Mercy
Hospital in Chicago and Pittsburgh. Training schools in nursing
were established in 1825, primarily due to the urging of Robert
Gooch, M.D. In Germany, the Rev. Theodor Fliedner and his wife
set up the Kaisersworth School of Deaconesses near Dusseldorf
in 1836 to train nurses to care for sick and convalescent patients.
Strictness was observed, uniforms were worn and theoretical institution
was given in a three-year course. Similar organizations were formed
in London and Boston. The Charity Hospital of New Orleans was
begun in 1737, but a teaching school for nurses was not inaugurated
until 1894. The Ursuline Sisters came to Canada in 1639, and in
1658, they established a school for nurses at the newly built
Hôtel Dieu Hospital in Montreal. In 1830, the Sisters of
Charity established the first hospital west of the Mississippi
River in St. Louis; it became the present DePaul Hospital.
In 1845, hospitals generally were recognized as places of wretchedness,
degradation and squalor, with a lack of sanitation. Fifty to 60
beds, less than 2 feet apart, were crammed into wards. Nursing
care, such as it was, was in the hands of uneducated, "immoral"
women who considered patients as necessary evils with whom to
contend. As one physician stated, "Drink was the curse of
the hospital nurse: the nurses are drunkards." Visiting friends
and family were the only reliable help to patients.
Into this vacuum came Florence Nightingale. Born into the family
of an English country gentleman, she received the proper education
and training to be a lady. She then traveled extensively in Europe,
ending in Geneva. On returning home, she became a part of English
society, attending balls and the busy society of the age. However,
she was of a rebellious nature and began to realize her "calling"
in life was to nurse the sick, which required a special type of
training. However, these ideas aroused great antagonism in her
family. Was this ambition of hers the reason she had been educated
as a promising young lady of society?
Nevertheless, Nightingale persisted in her quest, and in 1851,
at 31 years of age, she went to the Institute of Protestant Deaconesses
in Kaisersworth, Germany, under the direction of the Rev. Fliedner
for three months. She wrote: "We get up at 5:00, breakfast
at 5:45, etc. Several evenings in the week we collect in the Great
Hall for bible lessons. Now I know what it is to live and love
life." In 1852, she was appointed Superintendent of the Institution
for the Care of Sick Gentlewomen in Distressed Circumstances in
London, created by Lady Canning. Nightingale realized that what
she needed for the institute were superior types of nurses, who
were at that time nonexistent, so she planned to create a school
to train respectable, reliable, qualified and educated nurses.
However, the Crimean War then burst upon Britain, with many casualties
and none to care for them. In 1854, Sir Sidney Herbert, Secretary
of War, obtained approval to appoint Nightingale the "Superintendent
of the Female Nursing Establishment in Turkey," and later
that year, 38 nurses, 24 being professed nuns or Anglican sisters
and 14 being "professionals," left London for the Barracks
Hospital in Scutari. Nightingale and the group were not welcomed
by the British medical authorities, but they obtained a foothold
by improving the meals provided to the injured and by caring for
the sheer mass of casualties arriving (there were approximately
12,000 in the hospital). The Nightingale group gradually won the
respect of everyone. The patients adored them, the purveyors grew
to rely on Nightingale, and the doctors came to recognize the
value of the nursing abilities provided.
Meanwhile back in England, Nightingale became a heroine. A "Nightingale
Fund" was established, and more than 9,000 pounds was contributed,
which she used to improve the lot of the British soldier. After
the war, two figures emerged as being heroic -- the soldier and
the nurse.
Nightingale, however, became seriously ill and depressed and
accepted no public engagements for a time. Recently, Canadian
commentator James LeFanu, M.D., conjectured that Nightingale was
suffering from brucellosis contracted during the Crimean War.
In 1860, Nightingale founded the Nightingale School for nurses,
based out of St. Thomas' Hospital in London, with Mrs. Wardrope
as its matron. She believed that training and education had two
basic aims -- acquisition of knowledge and development of character.
It was a standard to which nurses had never been exposed. Strict
behavior was mandatory; they attended classes regularly, acted
as assistants on wards and received practical instruction from
physicians.
In 1897, at Queen Victoria's Diamond Jubilee celebrations, Nightingale's
fame was embellished with the public acknowledgement of her influence
in the progress of nursing as a distinct profession. There is
no doubt that Florence Nightingale should be revered as the founder
of modern nursing.
The founding of the Nightingale School coincided with the onset
of the Civil War in the United States in 1860. But the American
forces were no more equipped for the mass casualties in the Civil
War than was the British Army in Crimea. Early on in the conflict,
nurses were recruited primarily from Catholic orders: the Sisters
of Mercy, Sisters of Charity, Sisters of St. Vincent de Paul and
Holy Cross Sisters. An Anglican order also supplied some nurses.
In 1861, the Secretary of War appointed a Sanitary Commission,
and the Army Nursing Service was placed in the control of Dorothea
Dix, who was not a nurse but the former head of an insane asylum.
Eventually, some 2,000 women were recruited; not only was this
an inadequate number, but many of those who enlisted had no formal
nursing training. However, many provided much needed tender, loving
care to the soldiers, established adequate standards of cleanliness
and sanitation in the hospitals, and provided improvements in
available meals.
Numerous books have been written that detail the work that women
and nurses provided for the injured. For example, Mary A. Brody,
an Irish immigrant and wife of a lawyer, organized an association
of women who visited base hospitals to supply food, established
a depot of sanitary supplies, restored morale and often changed
dressings. "Mother" Byckerdyke of Illinois not only
performed great work in the field, but exercised common sense
and instilled the concept that the soldier was always right. She
set up washing machines in all Memphis army hospitals for the
first time, thereby promoting harmony between her and the physicians.
General Ulysses S. Grant gave her permission to go anywhere. Anna
Etheridge, or "Gentle Anna," combined true heroism with
quiet bearing, deferential manners and unobtrusive worth; "she
deserved a gold medal," so the soldiers said. The Sisters
of the Holy Cross in Mound City acted as efficient nurses in the
hospital and by their skill, quietness, gentleness and tenderness,
were invaluable. Mary Safford nursed in one of the Cairo hospitals
and overcame the opposition of doctors by her sweet manner, bringing
order out of chaos. She was loved by the soldiers. After the war,
she became a physician and professor at the Boston University
School of Medicine.
Following the Civil War, a number of nursing schools were established
in the United States, all being patterned according to the principles
established by Florence Nightingale. The Bellevue Hospital School
of Nursing in New York City was established in 1873; the New England
Hospital Nursing School in Boston, 1872; the Massachusetts General
Hospital School of Nursing, 1873, with six pupils; and the New
Haven Hospital School of Nursing, 1873.
Bibliography:
Adams GW. Doctors in Blue: The Medical History of the Union
Army in the Civil War. Dayton, OH: Press of Morningside; 1985.
Griffin GJ, Griffen JK. Jensen's History and Trends of Professional
Nursing. Sixth Edition. St. Louis, MO: C.V. Mosby Co.; 1969.
LeFanu J. What bugged Florence Nightingale? The Sunday Telegraph,
Toronto, Ontario, Canada; May 19, 1996.
Livermore, MA. My Story of the War. Hartford, CT: Worthington;
1889.
Moore F. Women of the War. Hartford, CT: S.S. Scranton
& Co.; 1867.
Woodham-Smith CB. Florence Nightingale, 1820-1910. New
York, NY: McGraw-Hill Book Co.; 1951.
C. Ronald Stephen, M.D., is a retired
anesthesiologist living in Chesterfield, Missouri. He is the Editor
of the Bulletin of Anesthesia History.
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