Nursing History and the Politics of Welfare

Ann Marie Rafferty, Jane Robinson

• Publisher: Routledge
• Year: 2005
• ISBN:
  9781134773534
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

A quiet revolution has been sweeping through the writing of nursing history over the last decade, transforming it into a robust and reflective area of scholarship. Nursing History and the Politics of Welfare highlights the significant contribution that researching nursing history has to make in settling a new intellectual and political agenda for nurses.
The seventeen international contributors to this book look at nursing from different perspectives, as it has developed under different regimes and ideologies and at different times, in America, Australia, Britain, Germany, India, The Phillipines and South Africa. They highlight the role of politics and gender in understanding nursing history and propose strategies for achieving greater recognition for nursing, and bringing it into line with other related health care professions.

Chapter 1

Nursing under totalitarian regimes: the case of National Socialism

Hilde Steppe

This chapter presents a small extract taken from my efforts over the last fifteen years to deal with a portion of our nursing history —the period of German National Socialism.

When I began my research, I was interested in filling in a gap in our history. It quickly became clear that this was not a normal gap but a deepseated taboo; touching it produced not so much a sense of satisfaction but instead mistrust, rejection and fear. This research has meant not only dealing with the history of my profession, but also dealing with the history of my parents’ and teachers’ generation and the history of my country where I was born in a refugee camp and later grew up. This research raised questions about my personal relationship to this period of history and my own defence mechanisms against the reality of nursing under National Socialism.

Opening myself to this process of reflection means that this work is not finished for me and so I can only share with you the present state of that knowledge.

In order to reconstruct this period of time I have analysed primary data found in a number of public and private archives. I have also used the methods of oral history by analysing the accounts given in nearly 200 written or personal interviews. In this chapter I will address four questions:

1. What was the special function of nursing during National Socialism?
2. How were nursing tasks performed by nurses at that time?
3. How, after 1945, did nursing deal with this period of history?
4. What lessons can we draw from this period of history?

In order to answer the question of the specific function of nursing, it is necessary to briefly describe the organization of German nursing before 1933.

During the second half of the nineteenth century, nursing was declared to be the ideal occupation for middle-class women and was completely reorganized. Up until that time, two relatively independent care systems had exisited—one, that of religious orders which based their care on the Christian concept of love for one’s neighbour, and the other of care for the sick by paid orderlies. The system of paid orderlies (Lohnwartsystem) evolved mainly in the Protestant areas of Germany after the Reformation, since the Catholic orders had been disbanded during the course of the Reformation. It was not until the first half of the nineteenth century that Catholic orders began to be refounded. At the same time, Lutheran nursing (Diakonissenrankenpflege) was developing on the Protestant side.^1,2,3 The socio-economic upheavals of the nineteenth century broke up these two systems, and a third branch of nursing emerged, that of independent nurses. The collapse of these two systems can be attributed to a number of factors. First, industrialization dissolved the system of domestic and family care and necessitated forms of public provision, like hospitals, in ever-increasing numbers. Second, the rapid development of medicine, which had become increasingly oriented towards the natural sciences, required at least passably well-trained and willing assistant staff to undertake all the activities in the field of diagnosis and therapy that had now become ‘unscientific’. Third, the development of civil welfare had supplemented and increasingly replaced the ecclesiastical caritas. Fourth, there was a struggle for emancipation, mainly among middle-class women, which had to be directed into socially acceptable channels by men. Fourth, as a result of the wars which took place in the nineteenth century, and under the influence, primarily, of the work of Florence Nightingale, it was declared that optimal medical care for the wounded should be a national duty of prime importance. Lastly, the final overcoming of feudalism in Europe paved the way for the establishment of bourgeoise society with its fixed moral and gender-specifice codes.⁴

By the ninenteenth century the task in hand was to react to the increased demand for nursing, which, in concrete terms, meant going beyond the ecclesiastical organizations and establishing the occupation as ‘socially acceptable’. However, this could only be accomplished by a successful appeal to a particular social class whose members would feel a strong commitment to the values represented by nursing. In the nineteenth century it was bourgeois women, in the main, who presented themselves as suitable for the task, since they had internalized the values of female morality. The demands of the bourgeois women’s movement to realize a gender-specific division of labour in the public sector meant opening up occupations to them which corresponded with the ‘female nature’. These demands were ideally suited to the establishment of the nursing occupation, since this occupation was guaranteed to fit well into the fixed frame of the patriarchal world picture. Independent nursing gradually established itself, actively promoted as it was by middle-class women who saw it as a way of entering the world outside the home and therefore as a step towards emancipation. It was also supported by male medical doctors who saw nursing as the position in health care allocated to women. The price that women had to pay for the support of men was the subordination of nursing to the absolute domination of medicine and the accompanying surrender of any shred of independence. Serving, giving of oneself, self-sacrifice and obedience became the intrinsic values of middle-class women’s nursing and so constituted the perfect professional ethical pitfall for all nurses. Self-awareness and selfdetermination were declared to be inappropriate and irreconcilable with the ‘ideal’ professional posture and stance.

In looking at this complex process of professional development, there are five main characteristics which can be identified:

1. The absolute subordination of nursing to medicine, where the one exists only by virtue of its relationship with the other;
2. The gender-specific nature of the nursing ideal; the complete intermingling of personal and professional qualifications resulting in an inability to develop any professional distance;
3. The limitless and never-ending boundaries of professional reponsibility;
4. The splintering of nursing into competing ideological groups;
5. The hostile stance of many nurses towards a collective occupational identity. As middle-class women, nurses did not want to be associated with the demands of the labour movement since such demands conflicted with nurses’ own view of themselves as individual professionals.

The effects of these vocation-specific traits culminated in a lack of professional independence, disagreement about professional policy, uncertainty about the scope and content of nursing, low societal recognition reflected in a lack of occupational security, and an unattainable constellation of professional ideals which, above all, resulted in a radical denial of their own needs.

Only against this backdrop is it possible to understand the developments in nursing which began in 1933 and the reaction of the nurses themselves to these developments.

I return now to the first question I posed, that of the specific function of nursing in National Socialism, which I want to clarify with respect to the following aspects: the incorporation of nursing into the National Socialist policies for health and for women; the terms of reference with regard to professional nursing practice; the tasks allocated to nursing; and the significance of nursing for the state.

National Socialist health policy was marked by extreme polarities, that is, simultaneous selection (of the best) and extermination (of the undesirable). Ideologically, policy was based on the concept of social hygiene and racial purity (eugenics). This political platform was not unique to the Nazis, but could be found, not only in Germany but also in other countries, as early as the late nineteenth century and was expressed in the ideology of social Darwinism.⁵ From this theory the Nazis took several central elements: the biologistic view of state and society, the idea of total state control, the necessity for propagation or active promotion of racially valuable characteristics and the elimination of the racially inferior classes, and the notion of the survival of the fittest.⁶

This led to a far-reaching paradigm shift in health care and to specific political action beginning in 1933. For example, in 1934 the law for the prevention of hereditary diseases was passed. This law set out the framework for compulsory sterilization. The humanistic and Christian healing tradition in which the focus was on the individual was sacrificed to the overarching needs of the health of the whole nation. The individual was now valued only for his contribution to the whole.⁷ Nazis reasoned that if an individual could not contribute to the whole, then this individual had no right to care by society; on the contrary, society had the right and the duty to banish this socially unfit person in order to preserve the health of all. The slogan for public health was ‘Vorsorge statt Fürsorge’ which translates roughly as ‘prevention not protection’, ‘cure not care’ or ‘public health not sentimental humanitarianism’.⁸

These health policies were binding for all health professionals. Nurses, who were numerically the strongest group in health care, were given special attention from the beginning. They were to play an important role in the health education of the people through their continual contact with the sick. They were also involved in both of the National Socialist extremes —in supporting the ‘worthy’ and in destroying the lives of those deemed ‘unworthy’.

The Head Office for Public Welfare issued the following declaration in 1936:

In the future nursing should be not only concerned with the sick and suffering, it should consist not ONLY in caring for the ill, in relieving the effects of poverty or current need. It must go further. Nursing must lead the people in questions of health. It is a nurse who should carry out the will of the State in the health education of the people.⁹

In addition to this not unimportant role in health policy, the professional structure of nursing fitted in very well with the gendered National Socialist image of the ‘natural task of the woman in the state’. From our perspective today, the Nazi women’s policy seems a very complex and contradictory construction; it has not yet been adequately researched. However, we can say there was no uniform policy that applied to all women since it was their racial identity which was the most important factor. Every regulation designed to benefit women automatically excluded a number of women who were seen to be racially unworthy.¹⁰

For the Nazi state, the ideal woman was the mother, the ‘bearer of blood and race’, so that her biological ability to give birth was also evaluated on the basis of her racial purity.¹¹ Also the working woman was seen positively, as long as she was in a job which was appropriate for her as a woman and which was seen as serving the people. Bertha Braun of the National Socialism women’s movement summed up the mood of ‘maternalism’. She argued that:

such phrases as ‘spiritual motherhood’ and ‘expanded motherliness’ could only mean a transference of the idea of selflessness and self-sacrifice in all areas of life, not only in natural motherhood. The authority of motherhood was based simply on the awe that every selfless sacrifice calls forth.¹²

Gertrud Scholtz-Kling, the Third Reich’s Women’s Leader, stated the basis for women’s work on 26 October 1934 at a political rally:

Women will find their place at all times and in all places where the work they are given is in the right relationship to their strength. Whether that strength is on an intellectual level or on another level is completely irrelevant. In every case, work achievement must always correspond to the strength and the inner spiritual orientation of the woman, and then all conflicts cease to exist.¹³

Thus, true motherhood was possible at home and at work and women’s vocations met the ideal insofar as they incorporated motherly aspects. The motherly vocation of nursing fitted this image quite well and therefore received public recognition. An advertising brochure from 1938 stated that ‘next to the task of motherhood a woman has no more beautiful and feminine an occupation than in the profession of a nurse’.¹⁴

The dual importance of nursing both as an ideal profession for women and as an influential factor in national health policy can also be seen in the state’s efforts to define the boundaries of nursing work and tasks. The stated intention of these measures was, on the one hand, to promote uniformity and tighten up organizational structures, and on the other, to conform with the professional concepts and content of the newly emerging nursing organizations. Toward this end the NSSchwesternshaft, Nazi Nursing Organization, which was to serve as a model for all other nursing organizations, was founded in 1934 as a suborganization of the Nazi party. As Erna Mach, a nurse and leader of the Nazi Nursing Organization, declared:

The primary task of training nurses in accordance with the wishes of Adolf Hitler and of joining together into a National Socialist organisation is uniquely the task of the NS Nursing Association. All other nursing in the future will have to orient itself to the thought and methods of this Association.¹⁵

All the larger organizations involved in nursing (the German Red Cross, Catholic and Protestant organizations, and independent organizations) were summarily subsumed into a Reichsfachschaft which operated under the auspices of the Ministry of the Interior which was a more or less statecontrolled umbrella organization. Men and women were segregated into separate organizations. Unions, socialist and communist nursing organizations were forcibly disbanded and their members required to join one of the recognized organizations. Jewish nurses were not admitted into either the umbrella organization or the Nazi Nursing Association, but neither was their organization disbanded. It was retained in order to continue to provide nursing care for Jewish people.

The many hitherto independent groups were amalgamated in 1936 into the Reichsbund Deutscher Schwestern und Pflegerinnen, the Reichsbund of German Nurses. Their members wore a blue uniform in contrast with the brown uniforms of the Nazi nurses. In 1942 the blue nurses and the brown nurses were joined into the ‘National Socialist Reichsbund of German Nurses’. Responsibility for nursing was delegated to the Nationale Sozialist Volkswohlfahrt (NSV), the National Socialist Welfare Organization, the largest organization in the Nazi Party. With regard to questions related to nurses’ training, nurses came under the jurisdiction of the Hauptampt für Volksgesundheit, Head Office of Public Health of the Nazi Party, all of whose key positions were occupied by doctors.

The attempts of a few nursing organizations to maintain their independence failed because the allocation of jobs and job promotion were tied to membership of one of the recognized organizations. In order to further control access to, and provision of, public services a Warnkartei (‘warning card file’) was created which soon came to be used extensively as a selection instrument to exclude from public service all persons deemed ‘unfit’. Those who had been excluded from public service were eligible only to work in private institutions, usually church-related.

In order to deal with the chronic shortage of nursing personnel, huge advertising campaigns were conducted in which the social importance of nursing was stressed. An advertising brochure of the time stated that ‘Men serve with weapons…women ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Tables
• Contributors
• Acknowledgements
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Chapter 9
• Chapter 10
• Chapter 11
• Chapter 12
• Chapter 13
• Chapter 14
• Chapter 15