Nursing and Women's Labour in the Nineteenth Century

The Quest for Independence

Sue Hawkins

• Editorial: Routledge
• Año: 2010
• ISBN:
  9781136990748
• Edición: 1
• Categoría: History
• Categoría: 19th Century History

This book presents a new examination of Victorian nurses which challenges commonly-held assumptions about their character and motivation. Nineteenth century nursing history has, until now, concentrated almost exclusively on nurse leaders, on the development of nursing as a profession and the politics surrounding registration. This emphasis on big themes, and reliance on the writings of nursing's upper stratum, has resulted in nursing history being littered with stereotypes. This book is one of the first attempts to understand, in detail, the true nature of Victorian nursing at ground level.

Uniquely, the study views nursing through an economic lens, as opposed to the more usual vocational focus. Nursing is placed in the wider context of women's role in British society, and the changing prospects for female employment in the high Victorian period. Using St George's Hospital, London as a case study, the book explores the evolution of nurse recruitment, training, conditions of employment and career development in the second half of the nineteenth century. Pioneering prosopographical techniques, which combined archival material with census data to create a database of named nurses, have enabled the generation – for the first time – of biographies of ordinary nurses.

Sue Hawkins' findings belie the picture of nursing as a profession dominated by middle class women. Nursing was a melting pot of social classes, with promotion and opportunity extended to all women on the basis of merit alone. This pioneering work will interest students and researchers in nursing history, the social and cultural history of Victorian England and women's studies.

1
The search for self-esteem

Developments in nursing in the late nineteenth century took place against a backdrop of social and scientific upheaval, and it is impossible to frame a discussion of ‘new nursing’ without placing it in this context. This first chapter will examine two themes which have particular relevance to the subject – the organization of healthcare provision in Victorian England and the changing role of women in Victorian society. Both made a significant contribution to the rise in respectability of nursing, which occurred in the second half of the century, and which, in turn, led to the emergence of the ‘modern nurse’.

Healthcare and the Victorians

Nineteenth-century healthcare in England resembled a complex web of institutions and practitioners (Rivett 1986). Most sick people were cared for at home, regardless of social background, and unlike today, hospitals were almost exclusively the domain of the poor. Among higher social classes, it was almost unheard of to venture inside a hospital as a patient (Woodward 1974; Summers 1989). In fact, the voluntary hospitals had a very narrow remit, focusing on certain classes of disease and a specific section of society. Chronic or ‘incurable’ cases were only reluctantly admitted, and admission was usually refused to those with infectious fevers; paupers were not welcome. Such patients were increasingly catered for in state-run institutions, such as the fever hospitals and workhouse infirmaries, which burgeoned in the second half of the nineteenth century (Crowther 1981; Ayers 1971).

In mid-century, workhouse infirmaries were little more than dormitories attached to the main workhouse building, where the sick were nursed by able-bodied female inmates. Louisa Twining, among others, led an outcry against conditions in the workhouses which resulted in a gradual improvement in both accommodation and quality of nursing. As the existing wards became increasingly overcrowded – populated by incurables, the elderly and the chronically sick – separate buildings began to appear, constructed specifically for their treatment (Crowther 1981; Kirby 2002). At the same time trained nurses were gradually introduced (Ayers 1971).

The voluntary hospitals and workhouse infirmaries could not be described as constituting a continuum within a system of healthcare, but operated in relative independence of each other. It was the emergence of Poor Law fever hospitals in London, under the auspices of the Metropolitan Asylums Board (MAB), which heralded the first centrally planned service. In the 1870s, five such hospitals were established in outlying areas of the capital, and all cases of notifiable infectious fevers, whether originating in Poor Law institutions, voluntary hospitals or elsewhere, were supposed to be sent to the new MAB hospitals (Rivett 1986; Ayers 1971).

Victorian asylums for the insane also formed a branch of the state sector, under the auspices of the Poor Law. Such institutions burgeoned in number and size from the 1830s on, as inmates with mental health problems transferred from overcrowded workhouses to relieve pressure on their accommodation. Unlike other institutions, the asylums employed large numbers of male nurses (Jones 1972; Carpenter 1980; Wright 1996).

Patients who could not, or would not, enter an institution had access to a range of alternatives, choice being dictated by their financial situation. Much of the burden for caring for the sick was carried by immediate family or neighbours, but even the poor could sometimes afford a domiciliary nurse (Summers 1989; Rafferty 1995; Wildman 2006). For those with the money, doctors and surgeons were always on hand to visit and treat patients in their own homes. The early domiciliary nurses were a heterogeneous and independent group of self-trained women, often employed by doctors, but who also worked on their own account (Summers 1989). With the emergence of nursing sisterhoods in mid-century this branch of nursing gradually became more formalized, and developed into two strands: private nurses for those who could pay and the forerunners of district nurses for those who could not. William Rathbone’s Liverpool Nursing Institution spawned a host of regional institutions for the sick poor in the 1860s, while a similar organization in London (headed by Frances Lees) evolved into the nationwide Queen Victoria Jubilee Institute for Nurses (Damant 2005; Sweet and Dougal 2008; Wildman 2006, 2009). Private nursing institutions did not necessarily restrict their activities to nursing either the poor or the better off. In fact, many used income generated by fee-paying clients to subsidize their work with those less fortunate.

Even within the voluntary sector there was growing diversification. Large teaching hospitals in metropolitan centres were complemented by cottage hospitals in urban and rural settings, and a breathtaking array of specialist hospitals emerged to treat all manner of conditions, such as St Mark’s Hospital for the Treatment of Fistula and The Oxygen Home ‘for the treatment of ulcers and wounds by Oxygen Gas’ (Granshaw 1981; Burdett 1900).

The growth of voluntary hospitals and home visiting institutions provides evidence of the philanthropic nature of Victorian society. From the smallest specialist to the largest teaching hospital, they relied upon public subscriptions and donations for survival (Rivett 1986).¹ While healthcare for the pauper classes was funded through the civic purse, the deserving poor relied on the goodwill and philanthropic ardour of their fellow man (Waddington 2000).

The voluntary hospitals (which form the focus of this book) were, therefore, just one element in a complex Victorian medical marketplace. They were important employers of nurses but were not the only option for women who chose nursing as a career. However, as we will see, they did become a primary locus of training, and by the end of the century, the majority of trained nurses would have passed through a voluntary hospital.

The changing role of women in Victorian society

The development of nursing during the Victorian period can only be fully understood in the context of wider societal changes, and in particular, the changing role of women in nineteenth-century England. The relocation of the nurse from the domestic setting into the hospital, nursing’s relationship with the medical profession, the schisms within the nursing profession and its supposed gentrification, must be situated alongside work in gender and women’s history.

The role of middle-class women in nineteenth-century society has been the subject of many conflicting narratives in the last 20 years, and can no longer be explained simply in terms of subordination to patriarchal dominance (Gleadle 2001). Recent scholarship, ‘led by feminist revival … combined with the growth of social history and the left-wing desire to recapture “history from below”’, has generated new perspectives (Gleadle 2001: 1).

The traditional view of a typical Victorian middle-class woman was summarized by Amanda Vickery:

A prisoner in the home, Mrs Average led a sheltered life drained of economic purpose and public responsibility. As her physicality was cramped by custom, corset and crinoline, she was … a delicate creature … conspicuously in need of masculine protection … prey to invalidism. And yet she abjured self-indulgence, being ever-attentive and subservient to the needs of her family. … She was immured in the private sphere and would not escape till feminism released her.

(A. Vickery 1998: 297)

Vickery’s portrait deliberately verges on caricature, but nevertheless, alludes to elements of Victorian society which are hard to refute. Most middle-class Victorian women did not work; their main focus was home and family; and they were outwardly influenced by Christian values. Their lives were governed by the ideology of domesticity; but traditional and feminist historians fervently disagree on the impact such ideology and its associated theoretical constraints had on Victorian women (A. Vickery 1998). While traditional historians continue to portray them as subservient creatures dominated by a patriarchal society, feminists – such as Gamarnikow and Vickery – argue that, far from submitting to the ideology, middle-class Victorian women used it to construct their own place in the public sphere (Gamarnikow 1991; A. Vickery 1998).

Several ideologies conspired to restrict Victorian middle-class women to their homes: Evangelicalism, the ideology of domesticity, and the concept of a society divided into two spheres (public and private) all played their part (Hall 1979; A. Vickery 1998; Summers 2000; Gleadle 2001; Davidoff and Hall 2002).

The rise of Evangelicalism in the early nineteenth century had a significant influence on the role of women. A highly influential (and principally Anglican) movement, which reflected many beliefs of earlier puritan Protestants, it had come to prominence at the end of the previous century, and continued to be dominant through the first half of the nineteenth. Evangelicals had two primary goals: to end the slave trade and to reform the nation’s morals and manners – endangered by the supposed collapse of civilized society (Davidoff and Hall 2002). Political and social unrest following the French Revolution, and the gathering pace of industrialization presaged a disintegration of civilization, it was feared (Boyd 1991; Thompson 1988; Best 1979). The agricultural and industrial revolutions, which caused massive relocation of people from the countryside to the cities, added to the ferment; out of which grew a form of paranoia among the upper classes, convinced that working men were on the brink of revolution (Cannadine 1998).

Evangelicals saw it as their duty to steer society back to stability. Led by an influential group of mercantile and landed gentry – known as the Clapham Sect – they used political influence rather than the pulpit to solicit support. Their first targets were the aristocracy and upper classes of society, and then focus switched to the emerging middle classes (Hall 1979). The political interests of the middle classes and the Evangelical movement were mutually supportive. While the middle classes provided a large and growing base for support of Evangelical reform, Evangelicalism’s political connections offered opportunities to take advantage of the newly extended franchise (Hall 1979; Cannadine 1998). Additionally, Evangelical morality, centred firmly on home and family, was seen as an effective antidote to the moral dangers of industrial capitalism. It transformed the home from a mere ‘place of peaceful refuge’ (as it had been portrayed the century before) into ‘a sacred place, a quasi-religious centre to men’s lives … and bulwark against … political subversion’ (Trudgill 1976: 39–41). The ‘Evangelical home’ offered a safe haven from the unparalleled pace of change afflicting Victorian society. The importance of Evangelicalism in defining Victorian society cannot be overstated; as Catherine Hall, has written, it ‘was probably the single most widespread influence in Victorian England’ (Hall 1979: 15).

The Evangelical ideology of domesticity had a profound effect on the role of women, especially when combined with early Victorian interpretations of natural differences between the sexes. Women were defined by their biological function to bear and raise children, and this alone would have been sufficient to confine them to the home. Their moral strength was questioned: they were weak in the face of temptation – an opinion which can be traced to belief in Original Sin – and driven by their emotions, unable to ‘disentangle their passions from their reasoning’. Adding physical weakness to the list, women were ill-equipped to face the dangers of the outside world (Burstyn 1980: 72). As a result they were ‘a source of constant anxiety to men [and] only with outside help from religion and from men who cared for them could women develop self control’ (Burstyn 1980: 72). In many respects, they were regarded by their menfolk as little more than ‘children of a larger growth’, their whims and fancies tolerated, as children’s were, but never taken seriously (Trudgill 1976: 67).²

This infantilization of women was reinforced through law. Until the Married Women’s Property Act of 1873, women had few rights, and even the children of a marriage were considered to be the property of the father. The introduction of the 1873 Act marked an irreversible decline in the autocratic authority wielded by husbands over their wives; but unmarried daughters remained tightly supervised, confined within the protective boundaries of the family (Harris 1993).

The Victorian view of women as weak innocents, in need of protection from corrupting forces, lies at the root of this protective relationship (Davidoff 1983). Complex chaperoning arrangements and close surveillance of daughters were essential for the protection of this innocence, loss of which rebounded not just on the unfortunate daughter, but on her whole family (Cominos 1980). The home was the natural place for women. Here, they could be protected from the ravages of the outside world and make best use of their inherent attributes, as wives and mothers. Paradoxically, within the home, women’s weaknesses became strengths – reinterpreted as nurture, empathy and morality – which could be mustered to protect the family against dissolute outside influences (Hall 1979). Predisposed to religion, by dint of purity and lack of exposure to moral dangers, women were regarded as the natural keepers of the family’s moral health and religious sensibilities (Hall 1979). Further, safe within the family, women acquired a wisdom and strength which was wholly missing from their ‘outdoor’ personas. As domestic ideology acquired importance in the fight against societal breakdown, women’s role as guardians of the ideology transformed them into proselytizers of middle-class morals and manners among the lower classes (Trudgill 1976).

Despite this central role in family life, women maintained a subordinate and deferential position to their husbands. Family structure mirrored that of society, which, according to Leonora Davidoff, was represented as an organic body of, ‘hierarchically ordered but interdependent parts’ (1983: 19). The Head (the ‘thinking organ’ or the brain) was represented in society by governing upper- or middle-class males, and in the family by the husband. The Hands (the ‘unthinking and unfeeling doers’) were society’s working classes, and servants in the domestic economy. Middle-class wives were the ‘Heart of the family, its Soul, the seat of tenderness, morality and the emotions’ (Davidoff 1983: 19). The analogy of women as the family’s heart and soul becomes important when considering the roles they were permitted to assume in the outside world.

The second defining ideology of the Victorian period, that of the ‘two spheres’, worked with domesticity to further restrict middle-class women’s movements. It followed logically from the Evangelicals’ world view. Outside the home – the public sphere – was danger, both moral and physical. It was the domain of men. Inside the home – the private sphere – was woman’s domain. Here, her natural, nurturing talents held sway (Hall 1979).

By the mid-nineteenth century, these two ideologies had become tightly woven into the fabric of middle-class life, and as the century progressed, despite a decline in the number of seriously religious, they had become synonymous with this section of society (Best 1985; Davidoff and Hall 2002). Although the old threats to society had receded, new ones emerged. Technological advances in transport and communication generated an almost frightening pace of life, and the home continued to represent a safe place of refuge from the outside world (Trudgill 1976).

From the 1870s, as the doctrine came under challenge from the nascent feminist movement, advances in scientific thinking were pressed into its support. A new understanding of reproductive biology enabled doctors to claim that women were in thrall to the ‘involuntary periodicity of their reproductive systems’; while Social Darwinists used evolutionary theory to ‘prove’ that women (like children, the working classes and native inhabitants of colonial lands) were naturally inferior to their menfolk (Poovey 1989; Davidoff 1983; Burstyn 1980; McDermid 1995; Vicinus 1985). Both arguments were used with great force to shore up the barriers which kept middle-class women from participating in the public sphere, which, by this time, were in danger of being breached.

The ideology was appropriated to promote specific causes. Trade unions used it to great effect to exclude women, accused of taking jobs from their better paid male colleagues, from the workplace. If women’s natural place was in the home, they argued, it followed that their presence in the workplace was unnatural (Rose 1992).

The domesticity/separate spheres construct was closely associated with yet another Victorian obsession, respectability; a combination which added further pressure on women to remain indoors. Respectability was an aspiration which permeated Victorian life across the classes (Best 1985; Thompson 1988). It was possible to be respectable and working-class, just as it was possible to be a member of the upper classes yet not respectable (Best 1985; Cordery 1995). Measures of respectability differed between the sexes, and were closely linked to gender attributes: male respectability entailed being strong, brave and independent; for women, it required sexual purity, domesticity and motherhood (Rose 1992). The most important attribute for men was independence, and the obligation to provide for the family was paramount. In a wor...

Índice

• Contents
• Illustrations
• Acknowledgements
• Introduction
• 1 The search for self-esteem
• 2 ‘The majority are ladies, a great many domestics’1
• 3 Probationer schemes
• 4 ‘Treat your good nurses well’
• 5 The development of nursing as a career
• 6 A quest for independence
• Appendix 1 Methodology
• Appendix 2 Comparison of nursing departments at 12 London hospitals, 1890s
• Appendix 3 Sample occupations of fathers (or mothers) of St George’s nurses
• Notes
• References
• Index