Richard Bates reviews ‘Locating Health: Regional Historical Perspectives on Human Care, 1800-1948, a one-day workshop part of ‘Florence Nightingale Comes Home for 2020’ project.
This one-day workshop, held at the University of Nottingham on 11 January 2019, was the first of a series of events being organised as part of Nottingham’s AHRC-funded project, ‘Florence Nightingale Comes Home for 2020’ (See: www.florencenightingale.org and http://blogs.nottingham.ac.uk/florencenightingale/). It featured ten papers from researchers broadly working on the history of healthcare in nineteenth- and early twentieth-century Britain. The call for papers asked how localised studies of historical health and care, and of individual healthcare institutions, can contribute to a broader understanding of the state of health and healthcare. It also invited participants to reflect on how hospital nursing, district nursing and women’s involvement in healthcare developed differently in different regions.
Professor Christine Hallett (Huddersfield)’s keynote, ‘The Lost Art of Nursing Revisited’, examined four central cultural associations that have served as both an anchor and millstone for the profession since Nightingale: religious self-abnegation; the gendering of nursing as female work; its association with dirt; and the centrality of physical and emotional labour to the profession. Christine identified the 1890s and 1990s as pivotal points at which nursing seemed to be moving in a more medico-scientific direction, and raised the question of where science belongs in nursing values and identity. If these four key values have at times appeared to dissolve, with nursing finding ballast in medico-scientific practice, has nursing thereby lost track of its moral and artistic aspects? Nursing work has always been complex, more so than medical work in the sense of its responsibility for the entirety of the patient’s experience.
Dr Claire Chatterton (Open University), opened the first panel, ‘Infancy and Insanity’, with an examination of two nineteenth-century asylums in Oxford, the Warneford Hospital and Littlemore Asylum. Her paper studied the move towards the ‘moral management’ of inmates, which promoted fresh air, good food, occupation and exercise over physical restraint, and saw the asylum staff referred to as ‘attendants’ and eventually ‘nurses’ rather than the earlier ‘keepers’. Good ‘attendants’ were expected to demonstrate intelligence, self-control, a sense of duty and observation, adaptability and tact. Claire’s presentation ended with an evocation of the contemporary uses of asylum buildings, and how contemporary society (and estate agents’ marketing material) deals with this aspect of the past.
Morag Allan Campbell (St Andrews) studied nineteenth-century asylums in Montrose and Dundee, with particular focus on women admitted with postnatal mental stress, or ‘puerperal insanity’. This was a highly gendered condition, related to Victorian concepts of home, motherhood and class. Patients demonstrating adherence to middle-class family values were diagnosed with ‘puerperal insanity’ more often than others who instead had their condition ascribed to drunkenness or poor morals. Compared to other inmates, women with ‘puerperal insanity’ received more sympathy, less stigma, and were discharged after a shorter time.
Sarah Rafferty (Cambridge)’s study took a quantitative approach to the decline in infant mortality 1891-1911. Infant mortality lagged behind general mortality, declining only from 1900 compared to 1850 for general mortality. The decrease has been attributed to a range of factors, from family size, nutrition or breastfeeding to the nature of the disease environment. Sarah tested these using a variety of statistical methods. The results showed that higher fertility led to higher infant mortality, as did giving birth in institutions, but that there was no association between infant mortality and population density. Further work on this topic will look into rates of infectious disease, and broaden the time period to 1870-1929.
Professor Alannah Tomkins (Keele) opened panel 2, ‘Nurses and Infirmaries’, with a paper on ‘Nursing the Provincial Infirmary to 1820’. Alannah analysed nurses working at seven of the 24 infirmaries to open between 1745 and 1780. Her study challenges some common ideas about pre-Nightingale nursing: while pay was low, and nurses’ status interchangeable with that of domestic servants, accusations of drunkenness were rare, and nurses’ skills were widely perceived as adequate to their task. These findings raise the question of why nurses’ reputation declined so quickly after 1820: we know that advances in medical knowledge placed different demands on nurses, but arguably domestic ideology undermined them still further
Professor Susan Hogan (Derby) looked at Nightingale herself, and whether or not Nightingale was a feminist. Susan deployed a reading of Nightingale’s works, and especially Notes on Nursing, which provides evidence both in favour of and against this idea. Nightingale told women not to automatically defer to doctors, and suggested they could educate themselves and play central roles in healthcare. But she also blamed women, placing responsibility for infant mortality on their defective household hygiene, and claiming that women were effectively murdering children through frivolity and a reluctance to learn hygiene and to educate themselves about the physiology of the body. Nightingale overlooked other factors involved in infant mortality, such as abortificants, disease, and wider public health issues.
Representing Southwell Workhouse, Jane Bench delivered a paper on behalf of the indisposed volunteer researcher Katherine Onion. Katherine’s paper showed how Workhouse sources such as Infirmary Committee minute books, local newspaper reports, and correspondence with the local government board can contribute to broader understandings of health in workhouse infirmaries. From these sources workhouse infirmaries and later workhouse hospitals such as those at Southwell emerge as an integral part of local healthcare provision as well as being their administrative hub. The demand for nurses in poor law infirmaries led to in-house nurse training and the formalisation of approved poor law infirmary training schemes.
Dr Steve Thompson (Aberystwyth) opened panel 3, ‘The Politics of Care’, with an assessment of the provision of healthcare in Welsh in the period 1850-1918. While 30.4% of the population of Wales was monoglot Welsh-speaking in 1891, this figure was significantly higher in north and west Wales, where non-Welsh-speaking doctors struggled to cater to the local population. Patients faced with such doctors felt disoriented, unable to express their needs. They felt that they were the subject of experiments, rather than actively involved in their care. The problem was particularly acute in asylums, where language was crucial to patient needs but where medical staff were typically English-speaking only. Steven’s paper raised questions about linguistic imperialism and about the importance of language in healing, especially in mental health, where ‘madness possesses national characteristics’.
Dr Sally Frampton (Oxford) reported on the early phase of the First Aid movement, especially St John Ambulance. Set up in the 1830s, with roots in the medieval Knights of St John, this took off in the 1870s, when it attracted wealthy Conservative politicians as patrons. Early first aid classes, run by doctors, proved popular and generated a thriving publishing industry. St John Ambulance classes initially targeted male manual workers, but it was soon found that most pupils were in fact women. This caused press controversy over ladies ‘playing at surgery’, and doctors feared it devalued their knowledge. This subject, often overlooked by health historians, seems ripe for further research.
Finally, Frances Cadd (Nottingham) presented on a 1938 masked march by London nurses, a protest against working conditions and a forgotten first in nursing history. Unofficially organised by the Guild of Nurses, the protest was led by four male and eight female protesters – though the press only reported on the latter – and attracted considerable public support. The nurses, one of whom, Avis Hutt, was also a political activist, were protesting their exclusion from decision-making and changed shift patterns, with a 9pm finish leaving them unable to take part in leisure activities. The image of the masked nurses was a powerful, uncanny one, and caused a media sensation.
Taken as a whole, the papers added a very rich layer of texture and nuance to attendees’ understanding of nineteenth- and early twentieth-century healthcare. A common theme was the emphasis placed on the importance of understanding interpersonal relationships in historical healthcare. Factors such as class status, language, and perceived adherence to key social values were crucial to the quality of care afforded and its place within the social relations of the day. The event sparked a number of new connections between researchers, which will no doubt lead to much fruitful future collaboration!
Dr Richard Bates is a research fellow in History at the University of Nottingham, attached to the AHRC project ‘Florence Nightingale Comes Home for 2020’. Richard’s research focuses on how ideas influence social change and in particular on the relationships between individual figures, social formations and political power. His PhD research examined the French psychoanalyst Françoise Dolto.