Jemima Short argues that a nineteenth-century lithograph found in Wellcome Collection speaks to inequalities in health care work today.
This article is part of a two-week takeover (1-14 June) of The Polyphony by Thinking Through Things, an ECR-led collaborative project designed to stimulate interdisciplinary dialogue around the holdings of Wellcome Collection. Thinking Through Things is supported by the Northern Network for Medical Humanities Research and is funded by a Wellcome Trust Discretionary Award. Following a training day co-hosted by Thinking Through Things and Wellcome Collection in February 2020, delegates were invited to submit a short text or creative response exploring one or more objects held by Wellcome Collection.
In this nineteenth-century lithograph, entitled ‘le mérite des femmes’ (the virtue of women), a nun brings her patient a drink.[i] The word mérite could be read in numerous ways – virtue, worth, merit, worthiness, credit – multiple-layers of value and morality are conveyed. The accompanying poem by Legouvé reads: ‘They appear as the very image of humanity, And those unfortunate persons for whom their kindness brings respite, Contentedly feel, perhaps even with love in their hearts, That a woman is the friend who brings them back to the light.’ The piece idolises this exemplary, anonymous woman as a symbol of all women who bring relief to the suffering. The woman pictured disappears behind her religious dress, her head bowed, her face barely visible. Anonymised, desexualised, and self-effacing: she is not an individual, but a model of feminine piety. Such representations were not uncommon, particularly in more conservative, Catholic circles.
I came across this object in Wellcome’s collection shortly after I defended my PhD thesis. My viva took place remotely as a global pandemic unfolded. My work on the labour of nursing nuns in nineteenth-century France, on the gendered hierarchies of labour and the language we use to discuss care, felt more relevant and more political than ever before against the backdrop of this global health crisis. This lithograph reinforces many of the themes I explore in my research, raising questions about who and what we value and about the politics of how we depict carers. These are issues of gender, the visibility of work, and the way labour is recognised and rewarded, issues which resonate as strongly now as they did in the 1800s.
There were more than 100,000 nuns working in France by the late nineteenth century, who made up a substantial workforce of teachers and nurses. Nuns ran French hospitals and hospices and worked as domestic nurses. They cleaned, cooked, dressed wounds and managed medicines. In a time when the success of medical interventions remained limited, the holistic care these women provided was among the best available. These women worked for free. Their labour could be arduous and dangerous, particularly as global epidemics of cholera swept across Europe in waves, the so-called second wave hitting London in 1832 and spreading to Paris, followed by subsequent waves in the 1850s to 1870s. As countries such as France became more industrialised, cities grew rapidly. Diphtheria, dysentery, scarlet fever, measles, chickenpox, smallpox, typhus, and typhoid all spread more easily in nineteenth-century urban areas with crowded populations and little sanitisation. In the face of widespread disease, nursing nuns cared for others in charitable institutions where self-sacrifice and overwork were lauded as signs of piety, to the extent that many fell ill and even died in service of their patients.
As a general rule, there were two opposing depictions of nursing nuns in France across the nineteenth and twentieth centuries. On one side, a newly emerging medical profession – from which women were excluded – sought to assert its authority in health care. Nuns were therefore dismissed as incompetent quacks, barriers to progress, and were gradually removed and replaced in the early twentieth century by a secular nursing profession. Some histories of medicine continue to replicate this attitude and belittle or overlook these women’s work. On the other side of the fence, more positive representations depicted these women not as workers or labourers, but rather as angel-like figures at the bedside. Their virtue and worth came from their gentleness, their femininity, their self-effacement, and often their martyrdom. What they did was charity, or an innate virtue, but rarely anything as mundane or as masculine as labour. Even as nuns were replaced by secular professionalised services, many of these ideals were maintained. Nurses were expected to be virtuous, chaste, modest, and self-sacrificing women.
Representations like this are political. The social prestige, salary, working conditions, and employer’s expectations of any job are shaped by the historical and cultural representations of the workforce and of the work itself. Nursing and care work have a long history of professional invisibility and of gendered and religious stereotype. Nursing is still considered a vocation, a term which disguises the emotional aspects of this work as something other than labour. Expectations of self-sacrifice and self-abnegation persist to this day in many countries around the world. By conflating care work with the identity of those performing it, by making certain elements of this work part of the ‘natural’ characteristics of the workforce, it becomes possible to disguise them as ‘not work’. Labour is ‘naturalised’ and therefore devalued, excluded from the usual forms of recognition or reward including fair wages and safe working conditions.[ii]
Let us now consider what is happening in our own healthcare services today. In the UK, NHS Digital statistics in 2019 show that women make up 89% of nursing and health visitors in the UK, and 77% of the overall NHS workforce.[iii] The figures in France are similar: a 2018 government report showed 87% of nurses were women.[iv] Care work remains an industry dominated by women where invisibility, precarity, and low pay are exacerbated by inequalities of gender, race, and class.[v] The Royal College of Nursing, Trade Unions and frontline staff are all calling for greater protection for healthcare workers who have not been provided with sufficient protective equipment during the current crisis.[vi] To make matters worse, PPE is often poorly adapted to women’s bodies as it was designed with a male body in mind, and there is little data available on how this might put female healthcare workers at greater risk.[vii]
Two weeks after my PhD viva, BBC Question Time featured the following exchange between the Health Secretary (Mr Hancock) and the Chief of the Royal College of Nursing (Ms Kinnair):
Mr Hancock: “Nurses, doctors, all healthcare professionals put themselves literally on the frontline. We’ve seen, very sadly, four doctors have died so far and some nurses…”
Ms Kinnair interrupts: “They’ve not even counted the nurses, Matt, I’ve got to have a conversation [about that].”
When asked by the host to repeat herself, Ms Kinnair says: “We haven’t even counted the nurses yet, because I keep asking for the stats on nurses that are ill.”
Mr Hancock responds: “I didn’t know that. We will sort that out,” before continuing to speak.[viii]
With such pressing issues concerning the safety of the workplace, the question of how we value nurses remains paramount. That word ‘mérite’ continues to evade definition. Virtue, worth, merit, worthiness, credit. Regular outpourings of claps, cheers, and rainbows for the angels of the NHS have become the norm, at the risk of emulating nineteenth-century France and simply idolising the self-sacrifice and overwork of our largely female nursing workforce. Will this appreciation translate into true recognition of that sacrifice, tangible improvements to the financial reward for this labour, or safe conditions for those doing the work?
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Dr Jemima Short is based at Newcastle University, where she has recently completed a PhD on Nursing Nuns in nineteenth century France.
References:
[i] The exact date of the work is unclear. The catalogue gives the dates of 1819-1876 for the lithographer, Jean-Paul Moynet.
[ii] This has been the subject of feminist scholarship and activism for decades. See for example Silvia Federici, Revolution at Point Zero: Housework, Reproduction, and Feminist Struggle (Oakland: PM Press, 2012).
[iii] https://digital.nhs.uk/news-and-events/latest-news/international-womens-day-2019
[iv] http://www.data.drees.sante.gouv.fr/ Rapports publics, Professions de Santé et du Social, La Démographie des autres Professions de Santé, Infirmiers (ADELI)
[v] “U.N. Women’s Report: Progress of the World’s Women,” progress.unwomen.org. See in particular pages 37 and 217.
[vi] https://www.independent.co.uk/news/health/coronavirus-nhs-ppe-equipment-shortage-infection-doctors-a9410436.html
[vii] See for example Caroline Criado-Perez, Invisible Women: Exposing Data Bias in a World Designed for Men (London: Chatto & Windus, 2019), in particular chapters 5 and 8. See also https://www.theguardian.com/world/2020/apr/24/sexism-on-the-covid-19-frontline-ppe-is-made-for-a-6ft-3in-rugby-player
[viii] Question Time (2020), BBC One Television, 2nd April, 20:05.
