Histories of nursing practice

Gerard M. Fealy, Christine E. Dietz Hallet

• Publisher: Manchester University Press
• Year: 2015
• ISBN:
  9781784996314
• Edition: 1
• Topic: History
• Subtopic: British History
• Index: History

How did skilled nursing practice develop to become an essential part of the modern health system? This book provides some important answers to this question. It traces the history and development of nursing practice in Europe and North America, exploring two broad categories of nursing work: the 'hands-on' clinical work of nurses in hospitals and the work of nurses in public health, which involved health screening, health education and public health crisis management. The book contains rich case studies of nursing practice across diverse settings in the nineteenth and twentieth centuries. As well as examining 'what nurses did', it explores the significance and meaning of nursing work, for nurses themselves, their patients and their communities, and examines developments in practice against a backdrop of social, cultural, political and economic drivers and constraints.This book will be of interest to academics and clinical nurses alike. It is also an ideal textbook for undergraduate nursing programmes, providing students with rich accounts of the history of their own disciplinary practice.

Part I

Care and cure in nursing work

1

Baby and infant healthcare in Dresden, 1897–1930

Bettina Blessing

Introduction

Until the end of the eighteenth century sick children were, for the most part, cared for at home and, if admitted to hospital, were cared for alongside adults. The first children’s hospital, the Hôpitale des Enfants Malades, was opened in Paris in 1802. In Germany the first children’s ward opened in 1829–30 at the Charité in Berlin with thirty to forty-five beds.¹ Some children’s hospitals had special baby wards.

Scientific interest in children began at the turn of the nineteenth century due, in part, to the emergence of modern scientific medicine, and, in part, to the social hygiene concerns of paediatricians who focused on the high incidence of illness among particular social strata and their obviously unhealthy lifestyles.² In Germany, interest in young children was not only driven by medical progress, but also by concerns that the next generation was endangered by the high infant mortality and the steep drop in the birth rate.³ The spectre of depopulation was continually conjured up, stirring the state, the communes and associations into action.⁴

Early professional infant healthcare in Dresden⁵

Around 1900 the baby wards of the children’s hospitals had a poor reputation because of their high mortality rates, which often exceeded 70 per cent. Regardless of social status, parents were not prepared to entrust their infants to the children’s hospitals.⁶ The high mortality rate was due to poor hygiene, malnutrition and insufficient knowledge of child and infant healthcare. Founded in December 1897, the Dresden Association Children’s Polyclinic and Infant Home in the Johannstadt district began to tackle these shortcomings and opened the world’s first hospital for babies on 1 August 1898 under the direction of the paediatrician Arthur Schlossmann (1867–1932). The aims of the Children’s Polyclinic and Infant Home were to treat poor children free of charge, to train baby nurses and to provide pure milk for the babies. Shortly afterwards, on 15 February 1899, a special school for the training of baby nurses was founded.⁷ That the first baby hospital was founded in Dresden is not surprising, since that city was at the forefront of the hygiene movement. One of its protagonists was the businessman Karl August Lingner (1861–1916), whose anti-bacterial mouthwash Odol was sold throughout the world. Lingner also initiated the first International Hygiene Exhibition in 1911, which attracted 5.5 million visitors, and he himself was active in the Dresden Association.

Arthur Schlossmann first opened a private outpatient clinic for babies and children in 1894 at 26 Photenhauer Strasse in Dresden. With the support of the Dresden Association, funding was secured and the paediatric outpatient clinic was extended. On 1 August 1898 Schlossmann established what was, according to the sources available, the world’s first in-patient hospital for sick babies on the first floor of the building at 1 Arnoldstrasse.⁸ Schlossmann described the initial conditions there as being far from ideal; the rooms were full to overflowing, with two to three children sometimes having to share one bed. The baby hospital had opened with just five beds and, although this number soon grew to twenty-two, the baby hospital was always filled beyond capacity.⁹ The hygiene standards advocated by Schlossmann were therefore often impossible to meet.¹⁰ Only gradually was he able to remedy the prevailing shortcomings and ultimately lead the baby hospital to success.

The growing acceptance of the baby hospital among the population led the Dresden Association to submit an appeal to the city of Dresden in 1901 to seek permission to build a new hospital. After much indecision, the Dresden City Council decided on 11 July 1903 to rent land to the Association at 4 Wormserstrasse.¹¹ Later in 1905 an additional baby ward was opened outside the town in the forest. Despite its success and growing popularity, the baby hospital was permanently in financial difficulties and, as a consequence, was placed under the administrative authority of the City Council from 1 January 1907.¹² By that time, however, Schlossmann had been appointed director of the Düsseldorf Children’s Clinic and had therefore no longer any influence on the development of the Dresden baby hospital.

The professionalisation of infant healthcare

From its inception, one of the aims of the Dresden Association was to train nurses for the care of sick babies and children. According to Schlossmann, healthcare for babies rested on three basic principles: well-trained specialist nurses for babies, asepsis and nutrition. Schlossmann had conceived infant nursing as a profession in its own right that was to be independent of general nursing. He did not envisage a professionalisation built on a foundation of general healthcare. Before baby nurses were introduced in Dresden, any state-recognised nurse could work as a baby nurse – in Dresden or elsewhere – without having to undergo special training.¹³ It is unclear if it was the Dresden Association that issued the first instructions for trainee baby nurses in Germany since their instructions are undated.¹⁴ The trainees were employed in the association’s baby hospital and polyclinic, but they could be called upon to serve as private nurses if required.¹⁵

The Dresden baby hospital trained its own nurses and deployed them as required. Schlossmann gave highest priority to the selection of trainee nurses.¹⁶ He believed that a girl was only suited to the profession if she

fully appreciates the responsibility she bears in the demanding service as a nurse for sick babies, understands the rationale for our measures, comprehends the implications of disregarding orders and is prepared to sacrifice her own convenience, thoughts, desires and views; only then can she be of service to our institution.¹⁷

Candidates for training applied in writing or personally to the matron.¹⁸ Only young women from educated families were to be accepted as trainee baby nurses.

Schlossmann believed that, in this way, he was opening up a career for them that had previously been the preserve of the uneducated. In his opinion, institutions like those in Vienna or Strasbourg were bringing up ‘nannies’, that is to say, women with no specific formal training. However, with his decision to train the ‘better educated’ Schlossmann did not break entirely new ground.¹⁹

Admission requirements and training

The admission requirements in the Dresden baby hospital stipulated, among other things, that applicants had to be eighteen years old. They were required to provide a certificate of health and submit a hand-written curriculum vitae, a photograph, their passport and birth certificate, as well as a letter of reference.²⁰ Trainee nurses were recruited from all over Germany.²¹

As a further requirement applicants were required to have attended a girls’ seminary. This precondition could be waived if the applicant had received some other form of higher education. Such proof of education was seen as a guarantee that the girls were able to follow the practical and theoretical tuition. Schlossmann felt vindicated in his approach by the fact that the number of applicants – who all came from educated families – exceeded the places available.

Attendance at a girls’ seminary, which tended to be fee-based and therefore affordable only for ‘better situated’ families, was not uncontroversial. Trainees in general nursing were required to have completed only elementary school, which meant that, according to t...

Table of contents

• Cover
• Half Title
• Series Information
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• Preface
• Introduction: Histories of nursing practice
• Part I Care and cure in nursing work
• Part II Public health and nursing work
• Index